del Nido cardioplegia in surgery for aortic root disease: a historically controlled study

Abstract

Background: To determine the safely and effectively of del Nido cardioplegia (DNC) in surgery for aortic root disease, with mild hypothermic cardiopulmonary bypass (CPB). Methods: From July to December 2017, all patients undergoing the surgery for aortic root disease (total aortic root replacement, valve-sparing aortic root replacement and replacement of aortic valve plus ascending aorta), with mild hypothermic CPB, were retrospectively reviewed at our institution. Patients were divided into two groups based on the type of cardioplegia: the classical blood cardioplegia (CBC group) and del Nido cardioplegia (DNC group). Demographics, operative details, perioperative data and postoperative complications were recorded and compared. A propensity score matching was performed in this study. Results: The preoperative data in DNC group were similar to CBC group. The volume of ultrafiltration was lower in DNC than CBC group (2,053.49±806.62 DNC vs. 2,666.00±967.14 CBC, P=0.001), when matched. The use of temporary pacemaker was more in DNC group (n=20, 46.5%, P=0.023), and the rate of automatic heart resuscitating was higher in the CBC group (92.0% vs. 72.1% DNC group, P=0.024, unmatched).There were no differences in in-hospital mortality, troponin T (mean 0.66 ng/mL for CBC group vs. 0.49 ng/mL for DNC group, P=0.152), left ventricular ejection fraction (mean 58.37% for CBC group vs. 60.07% for DNC group, P=0.395) or other postoperative complications between two groups, after matching. In subgroup analysis, the ultrafiltration volume was lower in DNC than CBC group (1,932.26±749.39 DNC vs. 2,640.00±996.24 CBC, P=0.004), when ACC time less than or equal to 90 minutes. The apache score was better in DNC group (4.75±3.41, P=0.041), when ACC time greater than 90 min. There were no statistical significances in other characteristics between groups.Conclusions: DNC is safe and effective for surgery for aortic root disease, not inferior to the CBC.

Analogy of Del Nido and conventional cardioplegia in patients undergoing isolated mitral valve replacement surgery: A single-center retrospective study

“…The findings of our study are in line with previously conducted study which states that cardiopulmonary bypass time was statistically significantly shorter in the del Nido group and Del Nido cardioplegia is safe and can be used efficiently in isolated valve replacement surgery. [17][18][19] Our study findings are also supported by recently published systematic review and meta-analysis on del Nido versus blood cardioplegia in adult cardiac surgery. 20 A previous study reported that decreased administration for patients receiving the Del Nido cardioplegia 16 which was inconsistent with this study as we found there was no significant statistical association between the type of cardioplegia and the possibility of receiving the RBCs transfusion.…”

Del Nido cardioplegia for myocardial protection in adult cardiac surgery: a systematic review and update meta-analysis

“…Forty-one studies regarding DNC versus CC for myocardial protection used in adult cardiac surgery were included in the final analysis. 7,8,20–58 On the basis of 9 retrospective observational studies we had previously included, another 32 studies published after September 2016 were included. Four of these studies were randomized controlled trials (RCTs), 24,36,39,43 one was a prospective observational study 20 while the rest were retrospective observational studies.…”

“…Thirty-eight and 39 studies respectively involving 21,391 and 21,595 patients reported CPB 7,8,20–31,33,35–42,44–58 and ACC time. 7,8,20–33,35–42,44…”

(Del Nido cardioplegia in adult patients)

“…V ostatních perioperačních datech nebyl žádný významný rozdíl. 25 S ohledem na chirurgickou revaskularizaci myokardu bychom rádi zmínili dvě velké retrospektivní studie. V roce 2019 publikují Timek a spol.…”

“…U nemocných, kde byl použit roztok del Nido, byla pozorována nižší potřeba transfuzních přípravků v perioperačním období. 15 Jiné studie poukazují na rozdílnou potřebu ultrafi ltrace během mimotělního oběhu, 20,25 která je vysvětlena nižším celkovým objemem kardioplegie nebo vyšším podílem krystaloidní složky v něm obsažené.…”