Comparison of del Nido Cardioplegia and Blood Cardioplegia in Aortic Root Surgery

del Nido Cardioplegia for Aortic Root Surgery

Authors

  • Yusuf Kuserli Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
  • Saygin Turkyilmaz Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey http://orcid.org/0000-0003-2165-6853
  • Gulsum Turkyilmaz Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
  • Ali Aycan Kavala Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

DOI:

https://doi.org/10.1532/hsf.2861

Keywords:

Delirium, Vitamin D, Open Heart Surgery

Abstract

Aim: To compare del Nido cardioplegia (DNC) with conventional blood cardioplegia (BC) in aortic root surgery.

Methods: Subjects who underwent aortic root surgery during a 3-year period were included. A DNC group was compared with a matched BC group.

Results: A total of 72 subjects were included, 36 who underwent DNC compared with 36 propensity-matched subjects who underwent BC. Fifty-one (70.8%) were male, and 21 (29.2%) were female, with a mean age of 66.19 ± 7.02 years (range 51 to 81). No significant differences in baseline characteristics, preoperative echocardiogram parameters, or intraoperative parameters were found between the groups. For DNC versus BC, cardiopulmonary bypass time, aortic clamp time, cardioplegia volume (all P = .001), and defibrillation (P = .007) were significantly lower. For postoperative biochemical parameters, creatinine levels at hour 24, potassium levels at hours 1 and 24, and glucose levels at hours 6 and 24 did not differ between the groups (P > .05). Creatine kinase-MB and troponin T levels at hours 1 and 24 were significantly lower in DNC versus BC (all P = .001). Hematocrit levels at hours 6 and 24 were significantly higher in DNC (P = .001). The groups did not differ in terms of postoperative inotropic support, postoperative complications, intubation period, or duration of intensive care unit stay (P > .05). Although the need for thrombocyte transfusion did not differ between groups (P > .05), DNC resulted in less use of erythrocyte and fresh frozen plasma transfusions (both P = .001). Postoperative ejection fraction was significantly better in the DNC group than in the BC group (P = .006).

Conclusion: The results indicate better intraoperative parameters and better ejection fraction rates with DNC than with BC. DNC is an effective and safe alternative to blood cardioplegia for aortic root surgery.

References

Ad N, Holmes SD, Massimiano PS, et al. 2018. The use of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial. J Thorac Cardiovasc Surg 155:1011-1018.

Ali JM, Miles LF, Abu-Omar Y, Galhardo C, Falter F. 2018. Global cardioplegia practices: Results from the Global Cardiopulmonary Bypass Survey. J Extra Corpor Technol ;50:83-93.

An KR, Rahman IA, Tam DY, et al. 2019. A systematic review and meta-analysis of del Nido versus conventional cardioplegia in adult cardiac surgery. Innovations (Phila) 14:385-393.

Doenst T, Borger MA, Weisel RD, et al. 2008. Relation between aortic cross-clamp time and mortality—not as straightforward as expected. Eur J Cardiothorac Surg 33:660-665.

Gorgy A, Shore-Lesserson L. 2019. Del Nido cardioplegia should be used in all adults undergoing cardiac surgery: Con. J Cardiothorac Vasc Anesth 33:1791-1794.

Kim K, Ball C, Grady P, Mick S. 2014. Use of del Nido cardioplegia for adult cardiac surgery at the Cleveland Clinic: Perfusion implications. J Extra Corpor Technol 46:317-323.

Kim WK, Kim HR, Kim JB, et al. 2018. del Nido cardioplegia in adult cardiac surgery: Beyond single-valve surgery. Interact Cardiovasc Thorac Surg 27:81-87.

Li Y, Lin H, Zhao Y, et al. 2018. Del Nido cardioplegia for myocardial protection in adult cardiac surgery: A systematic review and meta-analysis. ASAIO J 64:360-367.

Mongero LB, Tesdahl EA, Stammers AH, Stasko AJ, Weinstein S. 2018. Does the type of cardioplegia solution affect ıntraoperative glucose levels? A propensity-matched analysis. J Extra Corpor Technol 50:44-52.

Mukdad L, Toppen W, Sanaiha Y, et al. 2018. Incidence of cerebral microemboli in single-dose vs. multidose cardioplegia in adult cardiac surgery. J Extra Corpor Technol 50:143-148.

Nardi P, Pisano C, Bertoldo F, Ruvolo G. 2018. New insights on the use of del Nido cardioplegia in the adult cardiac surgery. J Thorac Dis 10(suppl 26):S3233-S3236.

Ota T, Yerebakan H, Neely RC, et al. 2016. Short-term outcomes in adult cardiac surgery in the use of del Nido cardioplegia solution. Perfusion 31:27-33.

Rosenbloom M, Hancock M, Weinstock P, et al. 2018. Del Nido cardioplegia for an aortic valve replacement patient with cold agglutinins. J Extra Corpor Technol 50(3):187-188.

Salis S, Mazzanti VV, Merli G et al. 2008. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth 22:814-822.

Sorabella RA, Akashi H, Yerebakan H, et al. 2014. Myocardial protection using del nido cardioplegia solution in adult reoperative aortic valve surgery. J Card Surg 29:445-449.

Valooran GJ, Nair SK, Chandrasekharan K, Simon R, Dominic C. 2016. del Nido cardioplegia in adult cardiac surgery—scopes and concerns. Perfusion 31:6-14.

Vistarini N, Laliberté E, Beauchamp P, et al. 2017. Del Nido cardioplegia in the setting of minimally invasive aortic valve surgery. Perfusion 32:112-117.

Published

2020-05-29

How to Cite

Kuserli, Y., Turkyilmaz, S., Turkyilmaz, G., & Kavala, A. A. (2020). Comparison of del Nido Cardioplegia and Blood Cardioplegia in Aortic Root Surgery: del Nido Cardioplegia for Aortic Root Surgery. The Heart Surgery Forum, 23(3), E376-E384. https://doi.org/10.1532/hsf.2861

Issue

Section

Article