Del Nido cardioplegic solution has the potential to provide superior myocardial protection in senescent hearts by preventing electromechanical activity during cardioplegic arrest and Ca(2+)-induced hypercontraction during early reperfusion.

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Background-There is increasing evidence that cardiopulmonary bypass (CPB) may be responsible for the morbidity associated with coronary artery bypass grafting (CABG) surgery. Recent developments in cardiac stabilization devices have made CABG without CPB feasible. However, there is conflicting evidence to date from published trials comparing outcomes between CABG performed with and without CPB, with some trials indicating an advantage to the avoidance of CPB and others showing little benefit. Methods and Results-In a single-center randomized trial, 300 patients requiring CABG surgery at a single institution were prospectively randomized to have the procedure performed with CPB (nϭ150) or on the beating heart (nϭ150). Exclusion criteria for the trial included emergency procedure, concomitant major cardiac procedures, ejection fraction Ͻ30%, and reoperation. In-hospital outcomes were analyzed on an intention-to-treat basis. A mean of 3.0Ϯ0.9 grafts were performed in the CPB group compared with 2.8Ϯ0.9 grafts in the beating-heart group (Pϭ0.06). There were no significant differences between the CPB group and the beating-heart group in mortality (0.7% versus 1.3%; Pϭ1.0), transfusion (8.7% versus 9.3%), perioperative myocardial infarction (0.7% versus 2.7%; Pϭ0.37), permanent stroke (0% versus 1.3%; Pϭ0.50), new atrial fibrillation (32% versus 25%; Pϭ0.20), and deep sternal wound infection (0.7% versus 0%; Pϭ1.0). The mean time to extubation was 4 hours, the mean stay in the intensive care unit was 22 hours, and the median length of hospitalization was 5 days in both groups (PϭNS). Conclusions-In

Background: A biomechanical model of the heart can be used to incorporate multiple data sources (ECG, imaging, invasive hemodynamics). The purpose of this study was to use this approach in a cohort of tetralogy of Fallot patients after complete repair (rTOF) to assess comparative influences of residual right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health. Methods: 20 rTOF patients who underwent percutaneous pulmonary valve replacement (PVR) and cardiovascular magnetic resonance (CMR) were included in this retrospective study. Biomechanical models specific to individual patient and physiology (pre-and post-PVR) were created and utilized to estimate the RV myocardial contractility. The ability of models to capture post-PVR changes of RV enddiastolic volume (EDV) and effective flow in pulmonary artery (Qeff) was also compared to expected values. Results: RV contractility pre-PVR (65±17 kPa, mean ± SD) was increased in rTOF patients in comparison to normal RV (39-45 kPa) (p<0.05). The contractility decreased significantly in all patients post-PVR (p<0.05). Patients with predominantly RVOTO demonstrated greater reduction in contractility (median decrease 35%) post-PVR than those with predominant pulmonary regurgitation (median decrease 12%). The model simulated post-PVR decreased EDV for majority and suggested an increase of Qeffboth in line with published data. Conclusions: This study uses a biomechanical model to synthesize multiple clinical inputs and give an insight into RV health. Individualized modeling allows us to predict the RV response to PVR. Initial data suggest that residual RVOTO imposes greater ventricular work than isolated pulmonary regurgitation.