Abstract
BackgroundHistidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are intracellular-type and extracellular-type solution respectively, both can provide a long period of myocardial protection with single-dose infusion, but studies comparing the two are rare for adult cardiac surgery. This study aims to evaluate whether DN is suitable for cardioplegia in complex and high-risk valve surgery with long-term cardiac ischemia when compared with HTK.MethodsThe perioperative records of adult patients infused with DN/HTK as a cardioplegic solution who underwent complex valve surgery with an expected myocardial ischaemic duration longer than 90 min between Oct 2018 and Oct 2019 were analysed retrospectively.ResultsOf the 160 patients who received DN/HTK and underwent complex valve surgery, we propensity matched 73 pairs. Both groups achieved satisfactory cardiac arrest effects, and no significant difference was found in their cTnI and CK-MB levels within 12 to 72 h postoperatively. The DN group had a higher rate of return to spontaneous rhythm (0.88 v 0.52, P < 0.001), a lower frequency of postoperative severe arrythmias (12% v 26%, P = 0.036), a higher postoperative stroke volume (65 v 59 ml, P = 0.011) and a higher cardiac output (6.0 v 4.9 L/min, P = 0.007) as evaluated by echocardiography, fewer transfusions and shorter ICU stays (both P < 0.05). The two groups had similar inotrope usage and similar incidences of low cardiac output, morbidities and mortality. Subgroup analysis showed that when the aortic clamping time was greater than 120 min, the advantages of DN were weakened.ConclusionsDN can be safely applied to complex valve surgery, and it has a similar myocardial protection effect as HTK. Further prospective studies are required to verify these retrospective findings.Trial registration retrospectively registered.
Highlights
Histidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are intracellular-type and extracellular-type solution respectively, both can provide a long period of myocardial protection with single-dose infusion, but studies comparing the two are rare for adult cardiac surgery
One possible reason is that HTK is an intracellular-type cardioplegia, while DN is an extracellular-type cardioplegia mixed with blood
Efficacy and myocardial protection effect of DN cardioplegia in adult complex valve surgery, we retrospectively compared this solution with the classic HTK solution
Summary
Histidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are intracellular-type and extracellular-type solution respectively, both can provide a long period of myocardial protection with single-dose infusion, but studies comparing the two are rare for adult cardiac surgery. Several studies have found beneficial effects of a longer cardiac ischaemia time with the use of single-dose cardioplegic infusion, such as with histidine-tryptophan-ketoglutarate (HTK) or del Nido (DN) solution [2,3,4], but both types. DN solution offers 60 to 90 min of arrest before redosing is required [4, 5], and HTK (Custodiol®) may offer even longer protection (more than 2 h) [6] Both HTK and DN cardioplegia have been applied in adult cardiac surgery for many years, but few studies have directly compared the two therapies. Efficacy and myocardial protection effect of DN cardioplegia in adult complex valve surgery, we retrospectively compared this solution with the classic HTK solution
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