Safety and Efficacy of Single Dose Del Nido Cardioplegia Solution in Left Ventricular Assist Device Implantation- A Propensity Matched Study

Abstract

Del Nido cardioplegia (DN) has recently become more in common use as a "single" dose cardioplegia in adult cardiac surgery. However, it is not well described in left ventricular assist device (LVAD) surgery. The purpose of this study was to summarize our clinical experience with single dose DN solution in LVAD implantation and to assess the safety and efficacy of our DN protocol by comparing with conventional cold whole blood cardioplegia (CWB). A total of 524 consecutive patients underwent LVAD implantation between July 2008 and August 2019. Among them, 137 patients who required aortic cross-clamp for concomitant cardiac procedures were included in this study. The DN protocol was to administer the initial dose as a single dose. CWB was given every 20 minutes. Propensity matching identified 40 matched pairs for analysis. Cross-clamp time was significantly shorter in the DN group compared with the CWB group (58± 20 min vs. 70± 33 min, p=0.0497). The retrograde cardioplegia technique was used in 6 (15.0%) patients in the DN group and 36 (90.0%) patients in the CWB group (p<0.0001). There were no significant differences in the rates of postoperative prolonged use of inotropes (>14 days) (DN: 3/40, 7.5% vs. CWB: 3/40, 7.5%, p=1), requiring postoperative right VAD (DN: 2/40, 5.0% vs. CWB: 2/40, 5.0%, p=1), and requiring blood transfusion (Table). Freedom from re-admission at 1 year was similar between two groups (DN: 69.6±7.7% vs. CWB: 74.3±7.5%, Log-Rank p=0.5522). Mid-term clinical outcomes in the patients undergoing LVAD implantation with the DN protocol was acceptable. This study showed the DN protocol was associated with shortened cross-clamp time and less frequent usage of the retrograde cannula technique.