Del Nido versus HTK cardioplegia for myocardial protection during adult complex valve surgery: a retrospective study

Abstract

Background Histidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are intracellular-type and extracellular-type solution respectively, both can provide a long period of myocardial protection with single-dose infusion, but studies comparing the two are rare for adult cardiac surgery. This study aims to evaluate whether DN is suitable for cardioplegia in complex and high-risk valve surgery with long-term cardiac ischemia when compared with HTK. Methods The perioperative records of adult patients infused with DN/HTK as a cardioplegic solution who underwent complex valve surgery with an expected myocardial ischaemic duration longer than 90 min between Oct 2018 and Oct 2019 were analysed retrospectively. Results Of the 160 patients who received DN/HTK and underwent complex valve surgery, we propensity matched 73 pairs. Both groups achieved satisfactory cardiac arrest effects, and no significant difference was found in their cTnI and CK-MB levels within 12 to 72 h postoperatively. The DN group had a higher rate of return to spontaneous rhythm (0.88 v 0.52, P < 0.001), a lower frequency of postoperative severe arrythmias (12% v 26%, P = 0.036), a higher postoperative stroke volume (65 v 59 ml, P = 0.011) and a higher cardiac output (6.0 v 4.9 L/min, P = 0.007) as evaluated by echocardiography, fewer transfusions and shorter ICU stays (both P < 0.05). The two groups had similar inotrope usage and similar incidences of low cardiac output, morbidities and mortality. Subgroup analysis showed that when the aortic clamping time was greater than 120 min, the advantages of DN were weakened. Conclusions DN can be safely applied to complex valve surgery, and it has a similar myocardial protection effect as HTK. Further prospective studies are required to verify these retrospective findings. Trial registration retrospectively registered.

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

“…While prior Asian studies mainly focused on juvenile patients and yielded favorable results for DNC cardioplegia, 24–26 our mixed multiracial Asian population-based study provides a broader representation. Although specific patient characteristics, surgeon training, and institutional procedures influence cardioplegia choice, our results align with studies showing DNC’s non-inferiority- in adult cardiac surgery.…”

del Nido and Histidine-Tryptophan-Ketoglutarate cardioplegia in minimally invasive mitral valve surgery: A propensity-Match study

“…Mechanical ventilation time did not differ between the two groupsmedian 0 [0-6] hours in HTK vs 0 [0-5] in del Nido, p = 0.55 -with more than half of the patients who were extubated on the operating table before being transferred to the Intensive Care Unit where the median stay was 23 hours and 23 [17][18][19][20][21][22][23][24] hours for HTK and del Nido (p = 0.42), respectively. One patient, in HTK group, suffered a cerebral stroke, while one patient, in del Nido group, experienced a transient neurologic deficit.…”

“…In patients with a crossclamp time <120 minutes, they found a lower incidence of transfusions of platelets and blood products as shorter MV time and ICU stay in patients who had del Nido cardioplegia versus HTK solution; however, these differences were no longer retained when crossclamp times exceeded 120 minutes. 23 There is limited literature focusing on outcomes of patients who underwent minimally invasive mitral surgery using del Nido cardioplegia. These studies provided a direct comparison between patients who had del Nido cardioplegia versus HTK or St Thomas solutions [12][13][14] and showed, by including operations with a median crossclamp time range of [54-76] minutes, equivalent results in terms of early mortality and morbidity and lower release of myocardial enzymes after del Nido cardioplegia.…”

“…In clinical practice, previous experiences focusing on adult cardiac surgery with long crossclamp time reported a myocardial protection strategy based on redosing del Nido cardioplegia after 60 minutes from the initial dose and every 60 minutes thereafter. [22][23][24]26,27 Based on the available literature, this strategy appeared safe and effective with comparable clinical outcomes and myocardial protection when using del Nido cardioplegia as an alternative to HTK solution and blood cardioplegia. For long crossclamp time, acceptable results were also reported with a mixed antegrade + retrograde delivery and the administration of a dilute solution -4:1 blood to crystalloid ratio instead of 1:4 blood to crystalloid ratiofor additional doses.…”

Variations in Electrolytes Level After Del-Nido Cardioplegia Administration in Patients Undergoing Congenital Heart Defects Surgery

“…3 For the very first time in history, del-nido cardioplegia was made to use in paediatric patients. 4 It is unique Four parts crystalloids to One part whole blood formulation that is used in single dose 20 ml/kg through ante-grade at 8-12 degree centigrade and retrograde at 4 degree centigrade. Del-nido cardioplegia reduce cross clamp time as single dose is effective for 90 minutes.…”