Comparison of del Nido's cardioplegia with St. Thomas's cardioplegia for myocardial protection in adult open-heart surgery

Abstract

Objective: The del Nido cardioplegia solution provides a long period of arrest with single dose as compare to St. Thomas cardioplegia solution. In our study we compared outcomes of del Nido and St. Thomas cardioplegia in adult open cardiac surgeries. Methods: Sixty patients were studied between January 2017 to December 2017. Out of which 30 patients were operated on St. Thomas cardioplegia and 30 patients were on del Nido cardioplegia solution. Outcome was compared in both group in relation to demographic, cardiac enzymes level, cardiopulmonary bypass data and post operative results. Results: Total cardiopulmonary bypass time (111.27 ± 40.791 vs. 131.77 ± 37.97, P = 0.049), Aortic cross clamp time (71.67 ± 27.68 vs. 87.00 ± 30.95, P = 0.048), Time taken for return of cardiac contraction after de-clamping the aorta (2.40 ±1.453 vs. 3.67 ± 1.971, P = 0.006), dose of cardioplegia required (1361.67 ± 362.388 vs. 2716.67 ± 927.021, P=0.001) repetition of Cardioplegia needed (1.37±0.490 vs. 4.07±1.437, P=0.001), time to wean off from bypass (21.93±4.934 vs. 32.67±10.535 , P=0.001) and intraoperative cardioversion requirement (p=0.001) were significantly lower in del Nido group as compared to St. Thomas group. Postoperative PRO BNP level (2269.8 ±2098.97 pg/mL vs. 10220.0 ± 8343.62 pg/mL, P= 0.001) was significantly lower in the DN group. While troponin T levels (P= 0.314), CPK-MB level (P=0.111) were comparable in between groups. Conclusion: Del Nido cardiplegia is associated with lower bypass and cross clamp time, less dose and repetition of cardioplegia and early return of cardiac activity as compared to ST Thomas solution. There is better myocardial protection with del Nido cardioplegia as assessed with less increase in PRO BNP level.