Alternative technique of long acting cardioplegia delivery results in less hemodilution.

Abstract

Preparation of del-Nido cardioplegia and its delivery technique can cause significant hemodilution. The resultant effects from hemodilution are largely proportionate to the use of a dual circuit. We opted for a custom-disposable single cardioplegia circuit instead of a dual circuit. We describe an alternative technique of del-Nido cardioplegia delivery and initial clinical experience with it at National University Hospital, Singapore. This is a retrospective analysis of data from January 2017 to April 2019, comprising of 177 patients of heart surgery and reflecting a single center database survey under the National Health Care Group. Of the 177 patients who underwent surgery with del-Nido cardioplegia, 76 (42.9%) were valve-only procedures and 5 (2.8%) were coronary artery bypass graft-only procedures. Ultrafiltration was utilized in 132 (62.6%) patients, whereas filtrate volume was 2200 [150-9500] mL. The alternative technique of del-Nido cardioplegia delivery adopted by National University Hospital advocates for a single pump, single circuit system. The retrospective institutional data highlighted safe delivery of del-Nido cardioplegia using this technique in a range of procedures. Besides the safe delivery of del-Nido cardioplegia, the National University Hospital Technique reduces hemodilution and provides other technical benefits including a steeper temperature gradient, modification of circuit configuration to deliver another cardioplegia while on bypass, as well as re-configuration of clamps to spike the base solution.