Excellent Restoration of Left Ventricular Compliance After Prolonged Del Nido Single-Dose Cardioplegia in an In Vivo Piglet Model

Nakao, Mitsutaka; Morita, Kiyozo; Shinohara, Gen; Kunihara, Takashi

doi:10.1053/j.semtcvs.2019.08.003

Cited by 12 publications

(9 citation statements)

References 31 publications

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“…Several studies have found beneficial effects of a longer cardiac ischaemia time with the use of single-dose cardioplegic infusion, such as with histidine-tryptophan-ketoglutarate (HTK) or del Nido (DN) solution [ 2 – 4 ], but both types are often compared with conventional blood cardioplegia (20–30 min interval). DN solution offers 60 to 90 min of arrest before redosing is required [ 4 , 5 ], and HTK (Custodiol®) may offer even longer protection (more than 2 h) [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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

Duan

Wang

et al. 2021

BMC Cardiovasc Disord

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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.

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Section: Introductionmentioning

confidence: 99%

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

Duan

Wang

et al. 2021

BMC Cardiovasc Disord

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“…Several studies have used pigs of both sexes to balance possible gender differences. However, there are also studies that exclusively used either male [ 40 , 41 , 49 , 57 , 58 ] or female pigs [ 21 , 48 , 59 , 60 , 61 , 62 ]. This can be influenced by additional experimental factors.…”

Section: Impact Of Breeds Strains Age and Sexmentioning

confidence: 99%

Relevance and Recommendations for the Application of Cardioplegic Solutions in Cardiopulmonary Bypass Surgery in Pigs

et al. 2021

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Cardioplegic solutions play a major role in cardiac surgery due to the fact that they create a silent operating field and protect the myocardium against ischemia and reperfusion injury. For studies on cardioplegic solutions, it is important to compare their effects and to have a valid platform for preclinical testing of new cardioplegic solutions and their additives. Due to the strong anatomical and physiological cardiovascular similarities between pigs and humans, porcine models are suitable for investigating the effects of cardioplegic solutions. This review provides an overview of the results of the application of cardioplegic solutions in adult or pediatric pig models over the past 25 years. The advantages, disadvantages, limitations, and refinement strategies of these models are discussed.

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“…Single-dose del Nido cardioplegia (DNC) has been used widely in congenital heart surgery for more than 20 years. Single-dose DNC has been shown to be safe and effective in pediatric patients and to provide a safe period of cardiac arrest for up to 120 minutes [ 1 , 2 ] . In recent years, DNC has also been shown to provide safe and effective myocardial protection in adults [ 3 - 7 ] .…”

Section: Introductionmentioning

confidence: 99%

Tepid Modified Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery: A PropensityMatched Analysis

Sevük¹,

Dursun²,

Ar³

2022

Braz J Cardiovasc Surg

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Introduction Del Nido cardioplegia was reported to provide adequate myocardial protection and clinical outcomes with improved surgical flow in adult cardiac surgical procedures. And many clinicians have already modified the traditional formula. This study aims to investigate the efficacy and safety of tepid modified del Nido cardioplegia compared to cold blood cardioplegia in adult patients undergoing cardiac surgery. Methods This retrospective study included one hundred consecutive adult patients undergoing cardiac surgical procedures using tepid modified del Nido cardioplegia. One hundred consecutive adult patients undergoing cardiac surgical procedures with cold blood cardioplegia were the control group. Propensity score matching yielded 89 modified del Nido and 89 cold blood cardioplegia patients. Results There were no significant differences when comparing the two matched groups regarding the requirement for intraoperative defibrillation ( P =0.36), postoperative peak troponin T levels (0.18), perioperative inotropic support ( P =0.26), intra-aortic balloon pump requirement ( P =0.62), and postoperative left ventricular ejection fraction at discharge ( P =0.4) and on the sixth postoperative month ( P =0.37). Mean cross-clamping time ( P =0.005), cardiopulmonary bypass time ( P =0.03), and total operation time ( P =0.03) were significantly shorter in the del Nido group. Conclusion Tepid modified del Nido cardioplegia may be a safe alternative to cold blood cardioplegia in adult patients undergoing cardiac surgical procedures.

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Excellent Restoration of Left Ventricular Compliance After Prolonged Del Nido Single-Dose Cardioplegia in an In Vivo Piglet Model

Cited by 12 publications

References 31 publications

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

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

Relevance and Recommendations for the Application of Cardioplegic Solutions in Cardiopulmonary Bypass Surgery in Pigs

Tepid Modified Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery: A PropensityMatched Analysis

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