Del Nido cardioplegia as a safe and effective method of myocardial protection in adult patients undergoing cardiac surgery: a single‑center experience

Abstract

Background Del Nido (DN) cardioplegia is increasingly popular in adult cardiac surgery. It allegedly allows for up to 90 minutes of safe myocardial ischemia with a single dose. aims We aimed to evaluate the benefits of DN cardioplegia. methods Of the 2108 patients undergoing coronary or heart valve surgery with the use of cardiopulmonary bypass (CPB) between January 1, 2016, and September 30, 2017, 1236 (59%) received DN and 872 (41%) received cold blood cardioplegia. We retrospectively analyzed the collected data of all consecutive on pump patients to assess early mortality and postoperative troponin T release. A multivariable analysis of both outcomes adjusted for propensity to receive DN cardioplegia was performed. results Patients protected with DN cardioplegia had longer CPB and aortic cross clamp times (P <0.001) but received fewer doses of cardioplegia. Median postoperative troponin T levels were higher in the DN cardioplegia than CB cardioplegia group: 0.324 ng/ml (interquartile range [IQR], 0.210-0.559 ng/ml) vs 0.285 ng/ml (IQR, 0.191-0.496 ng/ml); P = 0.01. However, when adjusted for the cross clamp time, propensity to receive DN cardioplegia, and other factors, DN cardioplegia was associated with lower postoperative troponin T levels. Early mortality rates did not differ between DN and CB cardioplegia (3.6% vs 3%; P = 0.54). conclusions Del Nido cardioplegia is a safe and effective method of myocardial protection in adults. It allows for a longer redosing interval with a safety profile and mortality comparable to those for CB cardioplegia, as shown by lower troponin T release when corrected for the time of myocardial ischemia.

Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood Cardioplegia: A Systematic Review and Meta-Analysis

“…Twenty-nine (29) studies were included in this systematic review and meta-analysis: three RCTs [4,14,15], two prospective observational non-randomised studies [16,17], 16 PMCS [7,8,[18][19][20][21][22][23][24][25][26][27][28][29][30][31], and eight unmatched retrospective cohort studies [5,6,[32][33][34][35][36][37] (Table 1). The majority of the studies used blood cardioplegia in a ratio of 4:1 (blood:crystalloid), with one study using an 8:1 ratio [29], and another study using only blood [4].…”

Long-Term Protective Effects of Single-Dose infusion of Warm Blood Cardioplegic Solution in a mini-pig model on the background of intraoperative anemia

“…The supplementary use of terminal warm blood cardioplegia achieved prolongation of the safe ischemic time up to 120 minutes for a single-dose application [18]. Kuciński J., (2019) found that Del Nido allows for up to 90 minutes of safe myocardial ischemia with a single dose compared with cold blood cardioplegia, as shown by lower troponin T release [19].…”

Del Nido cardioplegia in adult cardiac surgery: analysis of myocardial protection and post‐operative high‐sensitivity Troponin T

“…6,16 Kucinski and colleagues recently reported superiority for del Nido, when troponin values were measured as an isolated value the morning after surgery. 9 Ad and colleagues reported no significant difference in Troponin I values within 24 h of surgery. 3 The magnitude of troponin rise after cardiac surgery represents the sum of multiple sources of injury, including the level of injury prior to the patient arriving in the operating room, those made during cardiotomy for cannulation, exposure and incision of cardiac chambers and coronary arteries, myocardial ablation for treatment of arrhythmias, and myocardial cell injury due to ischaemia.…”

“…[4][5][6][7] The existing reports investigating post-operative troponin values for patients receiving del Nido have focused on the first 24 h post-operatively, and had small numbers of patients. [8][9][10][11] Following the introduction of del Nido into our practice, we sought to confirm equivalence of technique based upon clinical markers of myocardial protection, and hs-TnT profiles up to 72 h post-operatively, in two cohorts of patients receiving either del Nido or hyperkalemic blood cardioplegia.…”