Del Nido Cardioplegia can be safely administered in high-risk coronary artery bypass grafting surgery after acute myocardial infarction: a propensity matched comparison.

Halit Yerebakan,Robert A Sorabella,James Beck,Yoshifumi Naka,Estibaliz Castillero,Michael Argenziano,Mathew R Williams,Hiroo Takayama,Isaac George,Craig R Smith,Linda Mongero,Maliha Hossain,Marc Najjar,Emile Bacha

doi:10.1186/s13019-014-0141-5

Halit Yerebakan, Robert A Sorabella + Show 12 more

Open Access

https://doi.org/10.1186/s13019-014-0141-5

Copy DOI

Abstract

ObjectiveDel Nido (DN) cardioplegia solution provides a depolarized hyperkalemic arrest lasting up to 60 minutes, and the addition of lidocaine may limit intracellular calcium influx. Single-dose DN cardioplegia solution may offer an alternative myocardial protection strategy to multi-dose cold whole blood (WB) cardioplegia following acute myocardial infarction (AMI).MethodsWe retrospectively reviewed 88 consecutive patients with AMI undergoing coronary artery bypass (CABG) surgery with cardioplegic arrest between June 2010 to June 2012. Patients exclusively received WB (n = 40, June 2010-July 2011) or DN (n = 48, August 2011-June 2012) cardioplegia. Preoperative and postoperative data were retrospectively reviewed and compared using propensity scoring.ResultsNo significant difference in age, maximum preoperative serum troponin level, ejection fraction, and STS score was present between DN and WB. A single cardioplegia dose was given in 41 DN vs. 0 WB patients (p < 0.001), and retrograde cardioplegia was used 10 DN vs. 31 WB patients (p < 0.001). Mean cardiopulmonary bypass and cross clamp times were significantly shorter in the DN group versus WB group. Tranfusion rate, length of stay, intra-aortic balloon pump requirement, post-operative inotropic support, and 30-day mortality was no different between groups. One patient in the WB group required a mechanical support due to profound cardiogenic shock.ConclusionsDN cardioplegia may provide equivalent myocardial protection to existing cardioplegia without negative inotropic effects in the setting of acute myocardial infarction.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0141-5) contains supplementary material, which is available to authorized users.

Highlights

Despite advances in surgical technique and patient selection, mortality after coronary artery bypass grafting surgery (CABG) for acute myocardial infarction (AMI) remains high at 4-10% [1,2]
Operative data Use of Del Nido (DN) cardioplegia was associated with significantly shorter cardiopulmonary bypass (CPB) and Cross clamp (XC) times
A single cardioplegia dose was given in 33 DN vs. 5 whole blood cardioplegia (WB) patients (p < 0.001), and retrograde cardioplegia was used in only 8 DN vs. 31 WB patients (p < 0.001)

Summary

Introduction

Despite advances in surgical technique and patient selection, mortality after coronary artery bypass grafting surgery (CABG) for acute myocardial infarction (AMI) remains high at 4-10% [1,2]. Myocardial protection in this setting is complicated by subsequent ischemia-reperfusion injury, oxidative stress and intracellular Ca2+ overload [3], all of which may contribute to post-operative myocardial dsyfunction. Compared to the traditional 4:1 blood cardioplegia, DN is more dilute (1:4, blood:crystalloid), has lower Ca+2, and contains lidocaine (140 mg/L) (Table 1) (Compass-Baxter Healthcare Inc., Edison, NJ). We sought to evaluate the clinical outcomes of DN cardioplegia in CABG after AMI compared to standard 4:1 WB solution

Methods

Results

Conclusion