Del Nido Cardioplegia in Adult Cardiac Surgery: Meta-Analysis of Randomized Clinical Trials

Fresilli, Stefano; Labanca, Rosa; Monaco, Fabrizio; Belletti, Alessandro; D’Amico, Filippo; Blasio, Andrea Di; Kotani, Yuki; Landoni, Giovanni; Colangelo, Nicola; Simone, Francesco De; Gallio, Giulia; Aina, Alessandro; Buffa, Antonino; Rodriguez, Alcira; Vescovo, Antonella; Vlasakov, Iliyan; Futia, Giuliano Vincenzo

doi:10.1053/j.jvca.2023.02.045

Cited by 10 publications

(4 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a meta-analysis of randomized clinical trials, a reduced need of defibrillation was shown in patients who were given del Nido cardioplegia during open heart surgery. This can be explained by sodium and calcium homeostasis maintained by lidocaine that blocks the sodium channels and magnesium that acts as an antagonist to calcium, both of which are present in del Nido cardioplegia [28]. In our study, ventricular fibrillation rates were significantly lower while intraoperative cardiac re-beat period was longer in the del Nido cardioplegia group, which is consistent with the literature in terms of less requirement of defibrillation.…”

Section: Discussionsupporting

confidence: 90%

Comparison of Clinical Outcomes between del Nido Cardioplegia and Microplegia among Patients Undergoing Elective Mitral Valve Replacement

Hafız,

Altınbaş,

Kutlu

et al. 2023

HSF

View full text Add to dashboard Cite

Background: Cardioplegia solutions are used to protect the myocardium from ischemic injury caused by cardiopulmonary bypass and various types of cardioplegia solutions have been introduced for cardiac surgery. In this study, we aimed to compare the effects of del Nido cardioplegia and microplegia, which were mostly used in our clinic for intraoperative and postoperative processes among patients who underwent elective mitral valve replacement. As a result, the comparison could be performed in a specific patient group without additional valvular or coronary disease, and cardioplegia distribution could be achieved more efficiently. Methods: Between 2018 and 2023, a total of 120 patients who underwent elective mitral valve replacement via sternotomy with del Nido cardioplegia or microplegia were included in the study. Patients were divided into two groups; group 1 (del Nido, n = 64) and group 2 (microplegia, n = 56). Preoperative characteristics, intraoperative and postoperative early clinical data as primary outcomes, and postoperative mortality rates and intensive care costs as secondary outcomes were compared statistically. Results: There were no statistically significant differences in terms of preoperative characteristics between the two groups. Duration of cross clamp differences between group 1 versus group 2 (45 ± 16 vs. 57 ± 19 min), cardiopulmonary bypass (56 ± 17 vs. 65 ± 21 min), intensive care length of stay (18.04 ± 7.41 vs. 22.37 ± 6.86 h), requirement of intraoperative defibrillation (n = 5 vs. n = 13), and intensive care costs were found to be statistically significantly lower in del Nido group. Conclusion: Either del Nido or microplegia solutions can be used safely in mitral valve replacement operations, however, del Nido cardioplegia has some advantages over intraoperative processes, such as lowering the cross clamp and cardiopulmonary bypass time. Furthermore, patients who received del Nido cardioplegia had shorter intensive care stay and required less intraoperative defibrillation compared with the microplegia group. Therefore, less exposure to anesthesia, the prevention of infection due to shortened operation duration, and greater cost-effectiveness can be achieved by using del Nido cardioplegia instead of microplegia.

show abstract

Section: Discussionsupporting

confidence: 90%

Comparison of Clinical Outcomes between del Nido Cardioplegia and Microplegia among Patients Undergoing Elective Mitral Valve Replacement

Hafız,

Altınbaş,

Kutlu

et al. 2023

HSF

View full text Add to dashboard Cite

show abstract

“…The del Nido cardioplegia solution seems to be highly efficient in terms of myocardial protection and economic aspects. Nevertheless, the limited number of randomized trials in pediatric patients, and even fewer in adult patients, most of which are retrospective, constrains their overall value ( 7 , 14 , 38 ). Hence, there is a need for prospective and randomized studies to confirm the hypothesis regarding the viability or superiority of this cardioplegia in relation to others concerning myocardial protection.…”

Section: Discussionmentioning

confidence: 99%

Myocardial protection: comparing histological effects of single-dose cardioplegic solutions—study protocol for a secondary analysis of the CARDIOPLEGIA trial

Lira,

Delvaux,

Spadini

et al. 2024

J Thorac Dis

View full text Add to dashboard Cite

Background Myocardial protection is crucial for successful cardiac surgery, as it prevents heart muscle damage that can occur during the procedure. Prolonged hypoxia without proper protection can lead to adenosine triphosphate consumption, microvilli loss, blister formation, and edema. Custodiol, del Nido, and modified del Nido are single-dose cardioplegic solutions with proven safety and significance in modern surgery. While each has been independently assessed for patient outcomes, limited research directly compares them. This study aims to compare their myocardial protection using histological analysis. Methods In a double-blind clinical trial, at least 90 patients will be randomly assigned to receive one of the three cardioplegic solutions. Myocardial biopsies will be collected before cardiopulmonary bypass and 15 minutes after reperfusion. The surgical, anesthetic and perfusion techniques will be the same for all patients, following the Institution’s standard protocols. Discussion The ideal cardioplegic solution does not exist, and its selection remains challenging for surgeons. In modern surgical practice, understanding the behavior of these solutions and the ischemic tissue damage caused during induced cardiac arrest allows for safer surgical procedures. The results of this clinical trial can help in understanding the behavior of cardioplegic solutions and their tissue effects. Thus, by selecting the best cardioplegic solution, ischemic damage can be minimized, enhancing the effectiveness of this essential technique in cardiac procedures. The study may aid in implementing clinical protocols in several institutions, aiming to choose the solution with a superior myocardial protection profile, increasing safety, and reducing expenses. Trial Registration Brazilian Clinical Trials Registry (ReBEC, http://ensaiosclinicos.gov.br/ ): RBR-997tqhh. Registered: January 26th, 2022.

show abstract

“…Additionally, this study’s findings underscore the importance of examining various outcomes beyond 30-day mortality and MACE rates in cardiac surgery. In a recent meta-analysis conducted by Fresilli et al ., 30 the advantages of using DNC cardioplegia become even more evident. 31 Their research revealed significant reductions in outcomes such as stroke and postoperative acute kidney injury compared to STC.…”

Section: Discussionmentioning

confidence: 99%

Non-selective Del Nido and St Thomas cardioplegia in adults: analysis of early clinical experience using propensity matching

Sazzad,

Ong,

Ong

et al. 2023

Therapeutic Advances in Cardiovascular Disease

View full text Add to dashboard Cite

Background: Del Nido cardioplegia (DNC) is a single-dose, high potassium, low-volume cardioplegia solution that has grown in favor recently. However, the use of DNC in the Asian population may be associated with certain challenges. Methods: Between January 2017 and April 2022, DNC was used for myocardial protection in this single-center retrospective study. In total, 5731 patients underwent open heart surgeries, where 310 patients received DNC for single or multiple procedures. A total of 307 pair of propensity-matched patients from DNC and cold blood St. Thomas cardioplegia (STC) were compared. Results: In total, 5085 patients with STC and 310 patients with DNC from the cohort were matched, reflecting the initial group sizes before propensity matching. About 307 patient pairs were included in the final analysis after propensity matching with the interest variables. In the STC group, the requirement for an immediate postoperative intra-aortic balloon pump (IABP) was significantly higher [18 (5.9%) in DNC versus 28 (9.1%) in STC, p = 0.021]. A 30-day mortality was comparable between the DNC and STC groups (2.9% versus 3.3%, p = 1.00). Major adverse cardiac events (MACE) (2.6% versus 3.6%, p = 0.648) showed no difference between the groups. In both single and multiple procedure subgroups, there were no statistically significant differences in 30-day mortality and MACE incidences when comparing STC and DNC. Conclusion: The use of DNC in adults is acceptable and adaptable. Comparable clinical outcomes between STC patients and DNC were revealed by our investigation. There were no appreciable differences in 30-day mortality or MACE despite the STC group having a much higher need for immediate postoperative IABP.

show abstract

Del Nido Cardioplegia in Adult Cardiac Surgery: Meta-Analysis of Randomized Clinical Trials

Cited by 10 publications

References 27 publications

Comparison of Clinical Outcomes between del Nido Cardioplegia and Microplegia among Patients Undergoing Elective Mitral Valve Replacement

Comparison of Clinical Outcomes between del Nido Cardioplegia and Microplegia among Patients Undergoing Elective Mitral Valve Replacement

Myocardial protection: comparing histological effects of single-dose cardioplegic solutions—study protocol for a secondary analysis of the CARDIOPLEGIA trial

Non-selective Del Nido and St Thomas cardioplegia in adults: analysis of early clinical experience using propensity matching

Contact Info

Product

Resources

About