Does the type of cardioplegia used during valve surgery influence operative nadir hematocrit and transfusion requirements?

Stammers, Alfred H.; Tesdahl, Eric A.; Mongero, Linda B.; Stasko, Andrew

doi:10.1177/0267659118777199

Cited by 9 publications

(12 citation statements)

References 43 publications

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“…Moreover, there was no difference in perioperative hemoglobin and the need for allogenic blood transfusions, in accordance with the report by Stammers and colleagues. 19 The reduction in CPB and myocardial ischemic times with the use of DNS is in accordance with the findings of several other groups 3,5,6,8 and is probably related to the uninterrupted, expeditious performance of the surgical repair with less additional cardioplegia maintenance doses.…”

Section: Discussionsupporting

confidence: 87%

Del Nido cardioplegia versus blood cardioplegia in adult aortic root surgery

Lenoir

Bouhout

Jelassi

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionsupporting

confidence: 87%

Del Nido cardioplegia versus blood cardioplegia in adult aortic root surgery

Lenoir

Bouhout

Jelassi

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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“…In our study, the percentage of patients which required ultrafiltration in our study was 62.6%. This is lower compared to previous studies, which documented 83.7% 11 and 86% 13 of ultrafiltration usage in patients which had DNC administered. Although ultrafiltration cannot be considered as a direct measure of hemodilution, this preliminary observation highlights an indirect benefit of the NUH technique.…”

Section: Hemodilutioncontrasting

confidence: 72%

Alternative technique of long acting cardioplegia delivery results in less hemodilution

et al. 2020

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Background: Preparation of del-Nido cardioplegia and its delivery technique can cause significant hemodilution. The resultant effects from hemodilution are largely proportionate to the use of a dual circuit. We opted for a custom-disposable single cardioplegia circuit instead of a dual circuit. Methods: We describe an alternative technique of del-Nido cardioplegia delivery and initial clinical experience with it at National University Hospital, Singapore. This is a retrospective analysis of data from January 2017 to April 2019, comprising of 177 patients of heart surgery and reflecting a single center database survey under the National Health Care Group. Results: Of the 177 patients who underwent surgery with del-Nido cardioplegia, 76 (42.9%) were valve-only procedures and 5 (2.8%) were coronary artery bypass graft–only procedures. Ultrafiltration was utilized in 132 (62.6%) patients, whereas filtrate volume was 2200 [150-9500] mL. The alternative technique of del-Nido cardioplegia delivery adopted by National University Hospital advocates for a single pump, single circuit system. The retrospective institutional data highlighted safe delivery of del-Nido cardioplegia using this technique in a range of procedures. Conclusion: Besides the safe delivery of del-Nido cardioplegia, the National University Hospital Technique reduces hemodilution and provides other technical benefits including a steeper temperature gradient, modification of circuit configuration to deliver another cardioplegia while on bypass, as well as re-configuration of clamps to spike the base solution.

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“…It is controversial if the type of cardioplegia affects to the intraoperative hemodilution. 13,14 In this study, mean hematocrit after cardiopulmonary bypass was lower in the DN group than CWB group, and the DN group required more intraoperative PRBC transfusion. On the other hand, mean Hematocrit before cardiopulmonary bypass was also lower in the DN group compared with CWB group.…”

Section: Discussionmentioning

confidence: 52%

“…8.10.11 It was likely due to simplifying work flow with less frequent maintenance cardioplegia dose and less use of a retrograde cardioplegia cannula placement. 13…”

Section: Discussionmentioning

confidence: 99%

A proposed redosing interval of del Nido cardioplegia solution in adult cardiac surgery: a propensity-matched study

et al. 2020

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Background: Recently, del Nido cardioplegia solution (DN) has been utilized in adult cardiac surgery. However, adequate interval of maintenance dose(s) is still unclear. The purpose of this study was to assess the safety and efficacy of our DN protocol by comparing with conventional cold whole blood cardioplegia (CWB). Methods: A total of 1003 consecutive patients (DN group, N = 350 vs. CWB group, N = 653) underwent cardiovascular surgery between July 2013 and September 2018 were included in this study. The DN protocol was to administer 1000 to 1200 ml as an initial dose and to add maintenance dose(s) (500 ml each) every 60 minutes when the estimated cross-clamp time was over 90 minutes. CWB was given every 20 minutes, regardless of cross-clamp time. Propensity matching identified 254 matched pairs for analysis. The preoperative and postoperative data were reviewed. Results: Cross-clamp time was significantly shorter in the DN group compared with the CWB group (107 ± 56 minutes vs. 116 ± 49 minutes, p = 0.0458). A retrograde cannula was used in 124 (48.8%) patients in the DN group and 181 (71.3%) patients in the CWB group (p < 0.0001). There were no significant differences in requiring postoperative cardiac supports (inotropes, mechanical circulatory supports) and major complications. In-hospital mortality was similar between two groups (DN group: 3.2% vs. CWB group: 2.4%, p = 0.5872). Conclusions: Short-term clinical outcomes in the patients underwent cardiovascular surgery with the DN protocol including the redosing interval strategy were acceptable. Also, DN protocol was associated with shortened cross-clamp time and less usage of the retrograde cannula.

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Does the type of cardioplegia used during valve surgery influence operative nadir hematocrit and transfusion requirements?

Abstract: In patients undergoing cardiac valve surgery, the type of CP did not have a strong clinical impact on hemodilution or transfusion. Choice of a myocardial preservation solution can be made independently of its effect on intraoperative Hct.

Cited by 9 publications

References 43 publications

Del Nido cardioplegia versus blood cardioplegia in adult aortic root surgery

Del Nido cardioplegia versus blood cardioplegia in adult aortic root surgery

Alternative technique of long acting cardioplegia delivery results in less hemodilution

A proposed redosing interval of del Nido cardioplegia solution in adult cardiac surgery: a propensity-matched study

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