del Nido versus St. Thomas Cardioplegia Solutions: A Single-Center Retrospective Analysis of Post Cross-Clamp Defibrillation Rates

Abstract

There are many cardioplegia solutions currently in use for pediatric cardiopulmonary bypass (CPB). The most common being del Nido solution. Another common cardioplegia solution used for pediatric CPB is St. Thomas. In October 2014, Children's Mercy Kansas City changed from the use of modified St. Thomas to del Nido. This study compared rates of post cross-clamp fibrillation requiring defibrillation between del Nido solution and modified St. Thomas solution stratified by weight at Children's Mercy Kansas City. This retrospective study consisted of 394 patients who underwent cardiac surgery requiring cardioplegia between January 1, 2014 and July 31, 2015. The outcome measured was defibrillation upon cross-clamp removal. Statistical significance was determined using Fishers exact test with a two-sided significance level of .05. Incidence of defibrillation post cross-clamp removal was 4.4% in the del Nido group and 26.8% in the St. Thomas group (p < .0001). Analysis by weight stratifications displays a reduction in post cross-clamp defibrillation rates in groups using the del Nido solution. The 0- to 6-kg category had an incidence of fibrillation of 1.23% in the del Nido group and 17.5% in the St. Thomas group (p < .0003). The 6- to 15-kg category had an incidence of defibrillation of 1.82% in the del Nido group and 14% in the St. Thomas group (p < .0198). The 15- to 60-kg category had an incidence of defibrillation of 8.9% in the del Nido group and 61% in the St. Thomas group (p < .0001). The >60-kg category had an incidence of defibrillation of 16.7% in the del Nido group and 63% in the St. Thomas group (p < .0623). This study demonstrates a 6-fold decrease in the overall rate of defibrillation post cross-clamp removal between St. Thomas and del Nido cardioplegia solutions. Analyses of weight stratifications demonstrate a decrease in the rate of defibrillation post cross-clamp removal in all categories within the del Nido group.

Del nido cardioplegia in adults: a retrospective observational study in comparison to modified St. Thomas cardioplegia in cardiac surgery

“…Cardioplegia is a technique that temporarily halts the heart, safeguards the myocardium, and maintains normal heart function in patients undergoing cardiac surgery. The cardioplegic solutions contain crystalloid or blood-based substances, electrolytes, energy substrates, and pharmaceutical additives [ 1 – 3 ]. Del Nido (DN) cardioplegia is a well-known cardioplegia solution developed by Dr. Pedro Del Nido in 1990, which consisted of a blood-supplemented crystalloid solution with low potassium and calcium and high sodium and magnesium concentrations [ 4 – 6 ].…”

“…This cardioplegia formulation is well-known in the medical industry due to its extended duration of cardiac protection, ease of administration, and decreased re-dosing frequency. Yet, few studies have been conducted on its use in adults [ 3 , 4 , 7 – 17 ]. However, due to extended re-dosing intervals achieved with DN and advances in scientific research, it has become appealing for surgeons to extend its use in adults, where it has been reported to provide satisfactory outcomes [ 7 , 10 , 11 , 18 , 19 ].…”

Del Nido cardioplegia versus cold blood cardioplegia in adult cardiac surgery: a meta-analysis of randomized clinical trials

“…In the early 1990s, Pedro del Nido and his team developed this solution to protect immature myocardial cells [ 5 ]. Delivery of del Nido solution was administered in a 1:4 ratio of blood to crystalloid [ 6 ]. In the past few decades, del Nido cardioplegia has been widely used for intraoperative myocardial protection of congenital heart disease [ 7 ].…”