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Garg SK, Rawat RS, Saad DA, Omar I. Del nido cardioplegia in adults: a retrospective observational study in comparison to modified St. Thomas cardioplegia in cardiac surgery. J Cardiothorac Surg 2024; 19:266. [PMID: 38664851 PMCID: PMC11044565 DOI: 10.1186/s13019-024-02683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND St. Thomas cardioplegia is commonly administered to adults, yet repeated dosing at brief intervals is required. Del Nido's cardioplegic solution provides a prolonged duration of safe myocardial arrest, yet it was primarily intended for pediatric cardiac surgery. Recently, there has been an increasing interest in using Del Nido's in adults; this might be due to its ease of administration and extended re-dosing intervals. This study contrasted Del Nido's to modified St. Thomas cardioplegia in adults. METHODS This study was conducted on 200 patients. Troponin-T was the primary outcome within the first 24 and 48 h post-surgery. Cardiopulmonary bypass time, cross-clamp time, intraoperative use of inotropic support, defibrillator and/or intra-aortic balloon were the secondary outcomes of the study. RESULTS There was a significant reduction in post-operative Troponin-T levels in the first 24 and 48 h within Del Nido's group compared to the modified St. Thomas group. The cross-clamp and cardiopulmonary bypass times were also found to be lower within Del Nido's group. CONCLUSION This study has demonstrated a significant reduction in early postoperative Troponin-T levels as well as operative times favoring Del Nido's in adults.
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Affiliation(s)
| | | | - Dina Afifi Saad
- Cardiothoracic Surgery Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ihab Omar
- Cardiothoracic Surgery Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt.
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Borulu F, Arslan Ü, Çalik ES, Tayfur K, Erkut B. Comparison of Del Nido (a different application) and crystalloid blood cardioplegia on arrhythmia and early results. J Cardiothorac Surg 2024; 19:230. [PMID: 38627733 PMCID: PMC11020853 DOI: 10.1186/s13019-024-02675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/23/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The results of the use of del-Nido(DN) solution using a different method or crystalloid blood cardioplegia in coronary bypass patients were compared. We aimed to investigate the effects on intraoperative and postoperative arrhythmias, arrhythmia durations and early results. METHODS The study included 175 patients using crystalloid blood cardioplegia (Group 1) and 150 patients using DN solution(Group 2). In the DN group, 75% of the calculated plegia dose was given first. the remaining part was applied by giving from grafts. Intraoperative/postoperative data were compared. RESULTS There was no significant difference between the groups in terms of demographic characteristics. Preop troponin level was similar.(p = 0.190) However, there was a statistical difference between the postoperative 6th hour.(p = 0.001) There was no difference in troponin values at the postoperative 24th hour. (p = 0.631) Spontaneous rhythm occurred at the cardiopulmonary by pass (CPB) weaning stage in most of the patients in Group 2 (95.3%). Although the need for temporary pacing was less in Group 2, it was not significant.(p = 0.282) No patient required permanent pacing. CPB duration, cross clamp times and intraoperative glucose levels, intensive care follow-up times and hospitalization times were found to be shorter in Group 2. Although the postoperative atrial fibrillation frequency was similar (p = 0.261), the time to return to sinus was lower in Group 2.(p = 0.001). CONCLUSION The use of DN cardioplegia solution provides significant positive contributions to avoid arrhythmias compared to crystalloid blood cardioplegia. DN solution applied with this method may contribute to reducing the anxieties associated with its use in isolated coronary artery bypass surgery.
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Affiliation(s)
- Ferhat Borulu
- Faculty of Medicine, Department of Cardiovascular Surgery, Ordu University, Ordu, Turkey.
| | - Ümit Arslan
- Faculty of Medicine, Department of Cardiovascular Surgery, Atatürk University, Erzurum, Turkey
| | - Eyüp Serhat Çalik
- Faculty of Medicine, Department of Cardiovascular Surgery, Atatürk University, Erzurum, Turkey
| | - Kaptanıderya Tayfur
- Faculty of Medicine, Department of Cardiovascular Surgery, Ordu University, Ordu, Turkey
| | - Bilgehan Erkut
- Faculty of Medicine, Department of Cardiovascular Surgery, Ordu University, Ordu, Turkey
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Lira KB, Delvaux RS, Spadini FA, Hauschild LH, Ceron RO, Anschau F, Kopittke L, Rode J, Rey RAW, Wittke EI, Rombaldi AR, Cambruzzi E, Lopes ERC, Almeida AS. Myocardial protection: comparing histological effects of single-dose cardioplegic solutions-study protocol for a secondary analysis of the CARDIOPLEGIA trial. J Thorac Dis 2024; 16:1480-1487. [PMID: 38505015 PMCID: PMC10944752 DOI: 10.21037/jtd-23-1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/15/2023] [Indexed: 03/21/2024]
Abstract
Background Myocardial protection is crucial for successful cardiac surgery, as it prevents heart muscle damage that can occur during the procedure. Prolonged hypoxia without proper protection can lead to adenosine triphosphate consumption, microvilli loss, blister formation, and edema. Custodiol, del Nido, and modified del Nido are single-dose cardioplegic solutions with proven safety and significance in modern surgery. While each has been independently assessed for patient outcomes, limited research directly compares them. This study aims to compare their myocardial protection using histological analysis. Methods In a double-blind clinical trial, at least 90 patients will be randomly assigned to receive one of the three cardioplegic solutions. Myocardial biopsies will be collected before cardiopulmonary bypass and 15 minutes after reperfusion. The surgical, anesthetic and perfusion techniques will be the same for all patients, following the Institution's standard protocols. Discussion The ideal cardioplegic solution does not exist, and its selection remains challenging for surgeons. In modern surgical practice, understanding the behavior of these solutions and the ischemic tissue damage caused during induced cardiac arrest allows for safer surgical procedures. The results of this clinical trial can help in understanding the behavior of cardioplegic solutions and their tissue effects. Thus, by selecting the best cardioplegic solution, ischemic damage can be minimized, enhancing the effectiveness of this essential technique in cardiac procedures. The study may aid in implementing clinical protocols in several institutions, aiming to choose the solution with a superior myocardial protection profile, increasing safety, and reducing expenses. Trial Registration Brazilian Clinical Trials Registry (ReBEC, http://ensaiosclinicos.gov.br/): RBR-997tqhh. Registered: January 26th, 2022.
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Affiliation(s)
- Kathize Betti Lira
- Department of Cardiovascular Surgery-Postgraduate Program in Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
- Department of Education and Research-Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, RS, Brazil
| | - Renan Senandes Delvaux
- Department of Cardiovascular Surgery-Postgraduate Program in Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
| | - Felipe Abatti Spadini
- Department of Cardiovascular Surgery-Postgraduate Program in Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
- Department of Education and Research-Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, RS, Brazil
| | - Luis Henrique Hauschild
- Department of Cardiovascular Surgery-Postgraduate Program in Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
- Department of Education and Research-Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, RS, Brazil
| | - Rafael Oliveira Ceron
- Department of Cardiovascular Surgery-Postgraduate Program in Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
- Department of Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
| | - Fernando Anschau
- Department of Education and Research-Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, RS, Brazil
- Health Technology Assessment Center, Conceição Hospital Group, Porto Alegre, RS, Brazil
| | - Luciane Kopittke
- Department of Education and Research-Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, RS, Brazil
- Health Technology Assessment Center, Conceição Hospital Group, Porto Alegre, RS, Brazil
| | - Juarez Rode
- Department of Cardiovascular Surgery-Postgraduate Program in Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
- Department of Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
| | - Rafael Antônio Widholzer Rey
- Department of Cardiovascular Surgery-Postgraduate Program in Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
- Department of Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
| | - Estefania Inez Wittke
- Department of Cardiovascular Surgery-Postgraduate Program in Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
- Department of Education and Research-Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, RS, Brazil
- Department of Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
| | - Alfeu Roberto Rombaldi
- Department of Cardiovascular Surgery-Postgraduate Program in Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
- Department of Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
| | - Eduardo Cambruzzi
- Department of Pathology, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
| | | | - Adriana Silveira Almeida
- Department of Cardiovascular Surgery-Postgraduate Program in Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
- Department of Education and Research-Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, RS, Brazil
- Department of Cardiovascular Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, RS, Brazil
- Health Technology Assessment Center, Conceição Hospital Group, Porto Alegre, RS, Brazil
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Gu W, Qing H, Luo X, Zang X, Zhou K, Guo H, Zhou C, Guo H, Liu J. Del-Nido cardioplegia in cardiac surgery for elderly patients: a propensity score-matched analysis. J Cardiothorac Surg 2023; 18:161. [PMID: 37098556 PMCID: PMC10131453 DOI: 10.1186/s13019-023-02269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/04/2023] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVES To compare the safety and efficacy of del-Nido cardioplegia (DNC) with traditional 4:1 cold blood cardioplegia (CBC) in coronary artery bypass grafting and/or valve surgeries in elderly patients. METHODS The present study is a retrospective case-series study that included 302 consecutive patients aged 70 years and over who underwent on-pump valve surgery and/or coronary artery bypass graft (CABG). DNC was administered to 90 patients and CBC to 212 patients. After propensity-score matching, 89 pairs were compared. The safety and efficacy were analyzed between the two groups. RESULTS The DNC group had a similar mortality (3.4% vs. 5.6%, OR = 0.79, P = 0.720) and extracorporeal membrane oxygenation (ECMO) implantation rate (1.1% vs. 2.2%, OR = 0.75, P = 1.000) to the CBC group, a lower incidence of postoperative intra-aortic balloon pump (IABP) implantation (1.1% vs. 9.0%, OR = 0.54, P = 0.034) and a higher left ventricular ejection fraction (LVEF) at discharge (60 (56-64) % vs. 57 (51-62)%, P = 0.007). The estimated glomerular filtration rate (eGFR) in the DNC group was higher when the patient was transferred to the intensive care unit (79.4 (65.0-94.3) ml/min/1.73m2 vs. 77.2 (59.8-88.7) ml/min/1.73m2, P = 0.014), but no significant differences were identified after 24 h. The serum lactate values of the DNC group were significantly lower than those of the CBC group (0 h: 2.7 (2.0-3.2) vs. 3.2 (2.4-4.4), P = 0.001; 3 h: 3.2 (2.0-4.8) vs. 4.8 (2.8-6.6), P < 0.001; 6 h: 3.5 (2.2-5.4) vs. 5.8 (3.4-8.4), P < 0.001; 9 h: 3.4 (2.0-7.0) vs. 5.5 (2.9-8.3), P = 0.005). There were no differences between the two groups in respect of lactate levels at 12 h and thereafter. Postoperative creatinine kinase-MB concentrations were similar between the two groups. CONCLUSIONS Del-Nido cardioplegia is safe and effective in elderly patients undergoing CABG and/or valve surgery.
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Affiliation(s)
- Wenda Gu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Hongkun Qing
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Xiang Luo
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Xin Zang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Kan Zhou
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Haijiang Guo
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Chengbin Zhou
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Huiming Guo
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Jian Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China.
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Sazzad F, Ong ZX, Ong GS, Luo HD, Guim Goh S, Kofidis T, Vitaly S. Non-selective Del Nido and St Thomas cardioplegia in adults: analysis of early clinical experience using propensity matching. Ther Adv Cardiovasc Dis 2023; 17:17539447231210713. [PMID: 37991005 PMCID: PMC10666688 DOI: 10.1177/17539447231210713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Del Nido cardioplegia (DNC) is a single-dose, high potassium, low-volume cardioplegia solution that has grown in favor recently. However, the use of DNC in the Asian population may be associated with certain challenges. METHODS Between January 2017 and April 2022, DNC was used for myocardial protection in this single-center retrospective study. In total, 5731 patients underwent open heart surgeries, where 310 patients received DNC for single or multiple procedures. A total of 307 pair of propensity-matched patients from DNC and cold blood St. Thomas cardioplegia (STC) were compared. RESULTS In total, 5085 patients with STC and 310 patients with DNC from the cohort were matched, reflecting the initial group sizes before propensity matching. About 307 patient pairs were included in the final analysis after propensity matching with the interest variables. In the STC group, the requirement for an immediate postoperative intra-aortic balloon pump (IABP) was significantly higher [18 (5.9%) in DNC versus 28 (9.1%) in STC, p = 0.021]. A 30-day mortality was comparable between the DNC and STC groups (2.9% versus 3.3%, p = 1.00). Major adverse cardiac events (MACE) (2.6% versus 3.6%, p = 0.648) showed no difference between the groups. In both single and multiple procedure subgroups, there were no statistically significant differences in 30-day mortality and MACE incidences when comparing STC and DNC. CONCLUSION The use of DNC in adults is acceptable and adaptable. Comparable clinical outcomes between STC patients and DNC were revealed by our investigation. There were no appreciable differences in 30-day mortality or MACE despite the STC group having a much higher need for immediate postoperative IABP.
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Affiliation(s)
- Faizus Sazzad
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Centre for Translational Medicine, MD6, 14 Medical Drive, Level-8 (South), Singapore 117599, Singapore
| | - Zhi Xian Ong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Geok Seen Ong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Hai Dong Luo
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Si Guim Goh
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Theo Kofidis
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Sorokin Vitaly
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
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Abstract
Potassium homeostasis affects cardiac rhythm and contractility, along with vascular reactivity and vascular smooth muscle proliferation. This chapter will focus on potassium dynamics during and after cardiac surgery involving cardioplegic arrest and cardiopulmonary bypass (CPB). Hyperkalemic, hypothermic solutions are frequently used to induce cardioplegic arrest and protect the heart during cardiac surgery involving CPB. Common consequences of hyperkalemic cardioplegic arrest and reperfusion include microvascular dysfunction involving several organ systems and myocardial dysfunction. Immediately after CPB, blood potassium levels often drop precipitously due to a variety of factors, including CPB -induced electrolyte depletion and frequent, long-term administration of insulin during and after surgery. Meanwhile, some patients with pre-existing kidney dysfunction may experience postoperative hyperkalemia following cardioplegia. Any degree of postoperative hyper/hypokalemia significantly elevates the risk of cardiac arrythmias and subsequent myocardial failure. Therefore, proper management of blood potassium levels during and after cardioplegia/CPB is crucial for optimizing patient outcomes following cardiac surgery.
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Nowicki R, Bieżuńska-Kusiak K, Kulbacka J, Choromanska A, Daczewska M, Potoczek S, Rachwalik M, Saczko J. St. Thomas Modified Cardioplegia Effects on Myoblasts’ Viability and Morphology. Medicina (B Aires) 2022; 58:medicina58020280. [PMID: 35208603 PMCID: PMC8879905 DOI: 10.3390/medicina58020280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The cardioplegic arrest of the heart during cardiosurgical procedures is the crucial element of a cardioprotection strategy. Numerous clinical trials compare different cardioplegic solutions and cardioprotective protocols, but a relatively small number of papers apply to in vitro conditions using cultured cells. This work aimed to analyze whether it is possible to use the rat heart myocardium cells as an in vitro model to study the protective properties of St. Thomas cardioplegia (ST2C). Methods: The rat heart myocardium cells-H9C2 were incubated with cold cardioplegia for up to 24 h. After incubation, we determined: viability, confluency, and cell size, the thiol groups’ level by modifying Ellman’s method, Ki67, and Proliferating Cell Nuclear Antigen expression (PCNA). The impact on cells’ morphology was visualized by the ultrastructural (TEM) study and holotomograpic 3D imaging. Results: The viability and confluency analysis demonstrated that the safest exposure to ST2C, should not exceed 4h. An increased expression of Ki67 antigen and PCNA was observed. TEM and 3D imaging studies revealed vacuolization after the longest period of exposure (24). Conclusions: According to obtained results, we conclude that STC can play a protective role in cardiac surgery during heart arrest.
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Affiliation(s)
- Rafał Nowicki
- Department of Cardiac Surgery, Wroclaw Medical University, Curie-Skłodowskiej, 50-369 Wrocław, Poland;
- Correspondence:
| | - Katarzyna Bieżuńska-Kusiak
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Borowska 211A, 50-368 Wrocław, Poland; (K.B.-K.); (J.K.); (A.C.); (J.S.)
| | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Borowska 211A, 50-368 Wrocław, Poland; (K.B.-K.); (J.K.); (A.C.); (J.S.)
| | - Anna Choromanska
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Borowska 211A, 50-368 Wrocław, Poland; (K.B.-K.); (J.K.); (A.C.); (J.S.)
| | - Małgorzata Daczewska
- Department of Animal Developmental Biology, Institute of Experimental Biology, University of Wroclaw, Sienkiewicza 21 St., 50-335 Wrocław, Poland;
| | - Stanisław Potoczek
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wrocław, Poland;
| | - Maciej Rachwalik
- Department of Cardiac Surgery, Wroclaw Medical University, Curie-Skłodowskiej, 50-369 Wrocław, Poland;
| | - Jolanta Saczko
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Borowska 211A, 50-368 Wrocław, Poland; (K.B.-K.); (J.K.); (A.C.); (J.S.)
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Sithiamnuai P, Tocharoenchok T. Modified del Nido versus blood cardioplegia in congenital cardiac surgery. Asian Cardiovasc Thorac Ann 2021; 30:555-560. [PMID: 34553609 DOI: 10.1177/02184923211048332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lactated Ringer-based del Nido cardioplegia has been reported to be safe for acquired cardiac surgery. The original Plasma-Lyte-based solution has been proved for congenital cardiac surgery but its modification has not been adequately examined. We compared the clinical outcomes of congenital cardiac surgery using lactated Ringer-based del Nido cardioplegia versus cold blood cardioplegia. METHODS Between September 2018 and November 2020, 116 consecutive patients with congenital heart disease undergoing operations with cardioplegic arrest performed by a single surgeon at Faculty of Medicine Siriraj hospital; 66 with modified del Nido solution and 50 with institutional's blood cardioplegia. The patient risk profiles, operative details, mortality rates, care durations, inotrope use, blood transfusion and complications were compared. RESULTS Preoperative characteristics were similar between groups, including median age (2.5 vs. 3.1 years; p = 0.49), size, and gender. The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score of 3 to 5 was more prevalent in the del Nido group (24.2% vs. 10%; p = 0.049). There were 4 deaths in the modified del Nido group (risk category score of 4) but none in the cold blood group (p = 0.13). There was no significant difference in median intubation duration, length of intensive care unit stay, and vasoactive medications immediately and 24 h after the operation. The del Nido group required 70 to 100 ml less blood transfusion (p = 0.04). All complications were similar between the two groups. CONCLUSIONS Clinical outcomes of lactated Ringer-based del Nido cardioplegia were comparable to those of blood cardioplegia in congenital cardiac surgery.
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Affiliation(s)
- Pitipong Sithiamnuai
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Tocharoenchok
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Almeida AS, Ceron RO, Anschau F, Kopittke L, Lira KB, Delvaux RS, Rode J, Rey RAW, Wittke EI, Rombaldi AR. Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial. BMJ Open 2021; 11:e047942. [PMID: 34489276 PMCID: PMC8422325 DOI: 10.1136/bmjopen-2020-047942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Myocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study. METHODS AND ANALYSIS This is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters. ETHICS AND DISSEMINATION This protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field. TRIAL REGISTRATION NUMBER RBR-7g5s66.
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Affiliation(s)
- Adriana Silveira Almeida
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
- Health Technology Assessment Center (NATS) and Education and Research Center (GEP), Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafael Oliveira Ceron
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernando Anschau
- Health Technology Assessment Center (NATS) and Education and Research Center (GEP), Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciane Kopittke
- Health Technology Assessment Center (NATS) and Education and Research Center (GEP), Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Kathize Betti Lira
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renan Senandes Delvaux
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juarez Rode
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Estefânia Inês Wittke
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Alfeu Roberto Rombaldi
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
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Abstract
There is considerable interest and demand in the application of minimally invasive techniques in cardiac surgery driven by multiple factors including patient cosmesis and satisfaction, reduction of surgical trauma and the development of specialized instrumentation that allows these procedures to be performed safely. Minimally invasive mitral valve surgery (MIMVS) has been conducted for more than 25 years and has been shown to offer multiple benefits including better cosmetic results, enhanced post-operative recovery, improved patient satisfaction and most importantly, equivalent clinical outcomes with regards to quality and safety when compared to the standard sternotomy approach. MIMVS may be particularly beneficial in certain subgroups of patients, for example patients undergoing redo mitral valve surgery. In this article, we discuss patient selection criteria for MIMVS, the merits and drawbacks of MIMVS relative to conventional sternotomy approaches, and detail procedural aspects including anaesthetic management, intraoperative technique, and important considerations in myocardial protection and cardiopulmonary bypass (CPB). When considering developing a MIMVS programme, as for any new technique, a team approach to the introduction of the programme is essential. Although it is clear that patient selection is important, particularly early in a surgical programme, with experience complex repairs can be performed through a minimally invasive approach with excellent outcomes.
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Affiliation(s)
- Yasir Abu-Omar
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ibrahim T Fazmin
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Jason M Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Marc P Pelletier
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Guim GS, Wah Hoon CG, Lim CA, Chay-Nancy HS, Li Ler AA, Lim QX, Jaafar NB, Lim C, Sazzad F, Kofidis T. Use of del Nido Cardioplegia for Adult Heart Surgery: How Long Is Not Too Long? THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020; 52:272-278. [PMID: 33343029 PMCID: PMC7728503 DOI: 10.1182/ject-2000025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/06/2020] [Indexed: 11/20/2022]
Abstract
The most apparent practical advantage of del Nido cardioplegia (DNC) is that it allows the surgeon a longer arrest period before a subsequent dose is needed, as opposed to the conventional St. Thomas' cardioplegia solution where the recommended ischemic time is ∼15-20 minutes. In this study, we explored the incidence of arrhythmia after cross-clamp removal as a surrogate for a safe myocardial ischemic time with the use of DNC in adult heart surgery. A total of 113 patients who had undergone heart valve repair and/or replacement surgery at the National University Hospital, Singapore, were investigated. This single-center retrospective study was conducted on a population where DNC had been used for myocardial protection between January 2017 and April 2019. Cardioplegia ischemic time interval groups were not significant predictors of postoperative arrhythmia, defibrillation, and intraoperative intra-aortic balloon pump usage. Crude comparison of postoperative outcomes showed no significant differences in any other postoperative variables, including mortality and total hospital stay. From the results of the present study, it appears that there is no optimal ischemic time interval for the administration of DNC within a 120-minute time period. It is likely that DNC has a redosing interval of, and may provide adequate myocardial protection, for up to 120 minutes.
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Affiliation(s)
- Goh Si Guim
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Cindy Goh Wah Hoon
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Clara Anne Lim
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Huang Shoo Chay-Nancy
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Ashlynn Ai Li Ler
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Qi Xuan Lim
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Nurdiyana Binte Jaafar
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Cheryl Lim
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Faizus Sazzad
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Theo Kofidis
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
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12
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Shi H, Luo H, Qi X, Zhao H, Liu C, Chen H, Peng R, Yu Z, Hu K, Li X, Wang C. del Nido cardioplegia in surgery for aortic root disease: a historically controlled study. J Thorac Dis 2020; 12:4105-4114. [PMID: 32944322 PMCID: PMC7475601 DOI: 10.21037/jtd-20-1101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To determine the safely and effectively of del Nido cardioplegia (DNC) in surgery for aortic root disease, with mild hypothermic cardiopulmonary bypass (CPB). Methods From July to December 2017, all patients undergoing the surgery for aortic root disease (total aortic root replacement, valve-sparing aortic root replacement and replacement of aortic valve plus ascending aorta), with mild hypothermic CPB, were retrospectively reviewed at our institution. Patients were divided into two groups based on the type of cardioplegia: the classical blood cardioplegia (CBC group) and del Nido cardioplegia (DNC group). Demographics, operative details, perioperative data and postoperative complications were recorded and compared. A propensity score matching was performed in this study. Results The preoperative data in DNC group were similar to CBC group. The volume of ultrafiltration was lower in DNC than CBC group (2,053.49±806.62 DNC vs. 2,666.00±967.14 CBC, P=0.001), when matched. The use of temporary pacemaker was more in DNC group (n=20, 46.5%, P=0.023), and the rate of automatic heart resuscitating was higher in the CBC group (92.0% vs. 72.1% DNC group, P=0.024, unmatched).There were no differences in in-hospital mortality, troponin T (mean 0.66 ng/mL for CBC group vs. 0.49 ng/mL for DNC group, P=0.152), left ventricular ejection fraction (mean 58.37% for CBC group vs. 60.07% for DNC group, P=0.395) or other postoperative complications between two groups, after matching. In subgroup analysis, the ultrafiltration volume was lower in DNC than CBC group (1,932.26±749.39 DNC vs. 2,640.00±996.24 CBC, P=0.004), when ACC time less than or equal to 90 minutes. The apache score was better in DNC group (4.75±3.41, P=0.041), when ACC time greater than 90 min. There were no statistical significances in other characteristics between groups. Conclusions DNC is safe and effective for surgery for aortic root disease, not inferior to the CBC.
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Affiliation(s)
- Hui Shi
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haiyan Luo
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaomin Qi
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Zhao
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chaoqi Liu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongsong Chen
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Runsheng Peng
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhangsheng Yu
- Department of Bioinformatics and Biostatistics, SJTU-Yale Joint Center for Biostatistics, Jiao Tong University, Shanghai, China
| | - Kejian Hu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Li
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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