Del Nido cardioplegia in coronary surgery: a propensity-matched analysis

Abstract

OBJECTIVES Del Nido cardioplegia (DNC) has been shown to be safe in adults with normal coronary arteries who are undergoing valve surgery. This study compared the effects of DNC versus traditional blood-based cardioplegia on postoperative complications in patients who underwent coronary artery bypass grafting (CABG). METHODS A retrospective analysis was performed on 863 patients who underwent CABG with DNC (n = 420) or control cardioplegia (CC) (n = 443) between 2014 and 2017. The full cohort of DNC and CC recipients, as well as propensity score-matched pairs, was compared regarding preoperative risk variables and outcomes. RESULTS The DNC and CC groups showed no significant differences in mean cardiopulmonary bypass time (53.09 vs 52.10 min, P = 0.206) or aortic cross-clamp time (32.82 vs 33.28 min, P = 0.967). The groups also showed no difference in operative mortality (2.1% vs 2.5%, P = 0.734); however, DNC use resulted in lower rates of overall infections (1.7% vs 4.3%, P = 0.024), total sternal infections (0.9% vs 3.2%, P = 0.023), postoperative atrial fibrillation (23.8% vs 30.7%, P = 0.023) and postoperative ventricular tachycardia (0.5% vs 3.4%, P = 0.002). A propensity-matching analysis (n = 335 pairs) showed similar statistically significant decreases with DNC. CONCLUSIONS In this large cohort of CABG patients, DNC was shown as a safe alternative to CC and was associated with lower postoperative dysrhythmia and infection rates. These findings show that DNC is safe and effective in patients whose operative interventions may require only single-dosing cardioplegia; its use in longer cases should be further explored given its low complication rate.

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].…”

Pathology-related changes in cardiac energy metabolites, inflammatory response and reperfusion injury following cardioplegic arrest in patients undergoing open-heart surgery

“…The resulting myocardial injury is associated with postoperative morbidity and, in the long term, can lead to heart failure. Therefore, the search continues for an optimal cardioprotective cardioplegic solution (3)(4)(5)(6)(7). Understandably, most of the studies that have been conducted to assess cardioprotective interventions were done during coronary artery bypass graft (CABG) surgery and were uncritically extended to other pathologies (8,9).…”

(Del Nido cardioplegia in adult patients)

“…infekcí sternotomické rány. 27 Na konci roku 2020 je v Journal of ExtraCorporeal Technology publikována rozsáhlá multicentrická studie zvýšenou pravděpodobností prodloužené intubace, selháním ledvin nebo celkovou závažnou pooperační morbiditou či mortalitou. 28…”

“…Výskyt fi brilace síní v pooperačním období se v uvedených pracích liší. 15,26,27 Vlastní protektivní vliv kardioplegického roztoku lze kvantifi kovat na základě měření hodnoty kardiospecifi ckých enzymů, popřípadě na základě echokardiografi ckého vyšetření se zaměřením na změnu funkce/kontraktility myokardu komor. Klinické studie zahrnující sledování kardioenzymů ukázaly, že při použití roztoku del Nido jsou jejich hodnoty nižší ve srovnání s kontrolní skupinou.…”