A Systematic Review and Meta-Analysis of del Nido Versus Conventional Cardioplegia in Adult Cardiac Surgery

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Del Nido cardioplegia (DC) has been used extensively in pediatric cardiac surgery but the efficacy and safety in adults remains uncertain. Our objective was to perform a systematic review and meta-analysis comparing DC and blood cardioplegia (BC) in our primary endpoint of 30-day or in-hospital mortality as well as other efficacy and safety endpoints. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Both MEDLINE and EMBASE were searched from 1996 to 2017 for studies comparing DC and BC. Data were extracted by 2 independent investigators and aggregated in a random effects model. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> One randomized controlled trial ( n = 89), 7 adjusted ( n = 1,104), and 5 unadjusted observational studies ( n = 717) were included. There was no difference in in-hospital mortality between DC and BC (relative risk:0.67, 95% confidence interval [CI]: 0.22, 2.07; P = 0.49). DC reduced cardioplegia volume requirements (mean difference [MD]:−1.1 L, 95% CI, −1.6, −0.6; P &lt; 0.0001), aortic cross-clamp time (MD: −8 minutes, 95% CI, −12, −3; P = 0.0004), and cardiopulmonary bypass (CPB) times (MD: −8 minutes, 95% CI, −14, −3; P = 0.03). DC reduced troponin release (standardized MD: −0.3, 95% CI, −0.5, −0.1; P = 0.001). In-hospital outcomes of stroke, atrial fibrillation, acute kidney injury/dialysis, low cardiac output state, blood transfusion, reoperation rate, postoperative left ventricular EF, intensive care unit length of stay (LOS), and in-hospital LOS were comparable between groups. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> DC is a safe alternative to BC in routine adult cardiac surgery. Its use is associated with reduction in CPB and aortic cross-clamp times and may potentially offer improved myocardial protection. </jats:p></jats:sec>

Routine use of del Nido Cardioplegia compared to blood cardioplegia in all types of adult cardiac surgery procedures

“…Likewise, and similar to our findings, DNC was associated with reduced Troponin release (P = 0.001). 19 In contrast to aforementioned studies that included mostly low risk and relatively simple adult cardiac surgery procedures. Reports on use of DNC for more complex procedures have been limited.…”

“…Finally, we reported only short-term outcomes and weather DNC is associated with any potential long-term benefits is unknown. 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) 9 (7)(8)(9)(10)(11)(12)(13)(14) .10…”

Noteworthy Literature in Cardiac Anesthesia for 2019

“…These studies suggest that DN offers equivalent or superior myocardial protection in routine combined CABG/valve surgery. The equivalency or superiority of DN in lower-risk routine cases is summarized in a recent systematic review/meta-analysis by An et al 25 They examined studies comparing DN with blood cardioplegia published between 1996 and 2017. DN was associated with significantly lower cardioplegia volume requirements, decreased XC and CPB duration, and reduced troponin release.…”

Commentary: Easier is not always better than better

“…A single, small, randomized trial evaluating del Nido cardioplegia 8 and a meta-analysis 9 were hypothesis generating and indicated the need for a larger multicenter trial, as noted by Fremes and Tam. 10 Effective myocardial protection is imperative to prevent myocardial injury during global ischemia caused by the placement of an aortic crossclamp.…”