Abstract
BackgroundExclusive use of Del Nido cardioplegia administration in all adult patients undergoing cardiac surgery has been studied for operative, postoperative and myocardial protection outcomes.MethodsFrom November 2016 to October 2017, Del Nido cardioplegia was used in 131 consecutive patients (DN group). Using a propensity score, DN group was compared to 251 patients having received intermittent cold blood cardioplegia (CB group).ResultsPreoperative characteristics were similar in DN and CB groups. Operative outcomes were statistically different (p < 0.0001): cardiopulmonary bypass (CPB) time (DN 105.9 ± 46.5, CB 131.2 ± 38.8); aortic cross-clamp time (DN 80.8 ± 35.5, CB 102.2 ± 31.3); operative time (DN 203.1 ± 65.0, CB 241.5 ± 54.7); total cardioplegia volume (DN 1328 ± 879, CB 3773 ± 1226); and peak glycemia on CPB (DN 8.2 ± 2.3, CB 9.0 ± 1.8). No statistical differences were noted in intensive care unit stay, hospital stay and hospital death. Myocardial protection outcomes were similar: discharge left ventricular ejection fraction (DN 52 ± 11, CB 51 ± 10); Troponin levels at the end of the surgery (DN 871 ± 1623, CB 1958 ± 854), day 1 (DN 853 ± 1139, CB 993 ± 8234) and day 4 (DN 442 ± 540, CB 463 ± 317).ConclusionDel Nido cardioplegia use in all adult cardiac surgeries is associated with improved surgical efficiency. The design of larger trials including adults combined cardiac procedures and emergencies is needed.
Highlights
Exclusive use of Del Nido cardioplegia administration in all adult patients undergoing cardiac surgery has been studied for operative, postoperative and myocardial protection outcomes
This study reports the transition to Del Nido cardioplegia use among all adult cardiac surgical patients
Patient selection From November 2016 to October 2017, Del Nido cardioplegia was used in 131 consecutive patients (DN group) and compared using a propensity score to 251 patients who had received intermittent cold blood cardioplegia (CB group) and operated during the immediate period prior
Summary
Exclusive use of Del Nido cardioplegia administration in all adult patients undergoing cardiac surgery has been studied for operative, postoperative and myocardial protection outcomes. Myocardial protection is the cornerstone of cardiac surgery [1]. The wide spectrum of strategies for myocardial protection ranges from the beating heart to diastolic arrest with cardioplegia. Del Nido cardioplegia, extensively used in pediatric cardiac surgery, provides a bloodless quiescent operative field for a longer period than other cardioplegia solutions [4, 5]. This may improve the surgical flow and the patient outcomes
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