Propensity-Matched Analysis of Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery with Prolonged Cross-Clamping Time

Aims Initially developed for myocardial protection in immature cardiomyocytes, del Nido cardioplegia has been increasingly used over the past decade in adult patients. Our aim is to analyse the results from randomized controlled trials and observational studies comparing early mortality and postoperative troponin release in patients who underwent cardiac surgery using del Nido solution and blood cardioplegia. Methods A literature search was performed through three online databases between January 2010 and August 2022. Clinical studies providing early mortality and/or postoperative troponin evaluation were included. A random-effects meta-analysis with a generalized linear mixed model, incorporating random study effects, was implemented to compare the two groups. Results Forty-two articles were included in the final analysis for a total of 11 832 patients, 5926 of whom received del Nido solution and 5906 received blood cardioplegia. del Nido and blood cardioplegia populations had comparable age, gender distribution, history of hypertension and diabetes mellitus. There was no difference in early mortality between the two groups. There was a trend towards lower 24 h [mean difference −0.20; 95% confidence interval (CI) −0.40 to 0.00; I 2 = 89%; P = 0.056] and lower peak postoperative troponin levels (mean difference −0.10; 95% CI −0.21 to 0.01; I 2 = 0.87; P = 0.087) in the del Nido group. Conclusion del Nido cardioplegia can be safely used in adult cardiac surgery. The use of del Nido solution was associated with similar results in terms of early mortality and postoperative troponin release when compared with blood cardioplegia myocardial protection.

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“…Supplemental Table 4, http://links.lww.com/JCM/A545 lists the 42 studies ultimately included in this meta-analysis 15–28,30–34,36–40,43,46–48 …”

Section: Resultsmentioning

confidence: 99%

“…The PRISMA search flow diagram and checklist are available in Supplemental Figure 1 Supplemental Table 4, http://links.lww.com/JCM/A545 lists the 42 studies ultimately included in this meta-analysis. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][30][31][32][33][34][36][37][38][39][40]43,[46][47][48]…”

Section: Study Selectionmentioning

confidence: 99%

del Nido versus blood cardioplegia in adult cardiac surgery: a meta-analysis

Malvindi

Tian

Bifulco

et al. 2023

Journal of Cardiovascular Medicine

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“…In this case, we decided to use del Nido cardioplegia to minimize cardioplegia delivery times. Some recent studies have shown good outcomes using del Nido in a complex cardiac procedure in adult patients [ 8 – 10 ].…”

Section: Discussionmentioning

confidence: 99%

Type A aortic dissection after Coronary Artery Bypass Grafting

Hajiyev,

Qubadov,

Maharramova

et al. 2024

Am J Case Rep

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Patient: Female, 65-year-old Final Diagnosis: Aortic dissection Symptoms: Thoracic pain Clinical Procedure: — Specialty: Cardiac Surgery Objective: Rare disease Background: Aortic dissection is rare after coronary artery bypass grafting (CABG), but it is a potentially fatal complication of cardiac surgery. Reoperation may pose problems with thoracotomy, adhesiolysis, and myocardial protection. No standard treatment guidelines exist for chronic aortic dissection after CABG. We present a case of chronic type A aortic dissection after cardiac surgery, which was successfully treated. Case Report: A 65-year-old female patient presented with a medical background of hypertension, type 2 diabetes mellitus, and hyperlipidemia. No connective tissue disorders were diagnosed. The aortic valve was tricuspid. Three years ago, she underwent coronary artery bypass grafting involving 4 branches at a different medical facility. She reported chest pain weeks after bypass surgery, which gradually increased. Aortic dissection was observed in the latest contrast-enhanced CT scan, beginning from just above the sinotubular junction and reaching below the brachiocephalic trunk. Two grafts from the saphenous vein were patent, and 1 was lying just below the sternum. Cardiopulmonary support was initiated by cannulating the right femoral artery and vein. An opening in the ascending aorta exposed an intimal tear near the proximal anastomosis of the 2 great saphenous vein grafts. Antegrade del Nido cardioplegia was given through native ostia and functional bypass grafts. Proximal and then distal anastomosis of the graft prosthesis was performed. A new venous graft was anastomosed to the apical part of the left anterior descending artery (LAD). This saphenous vein and the buttons of the 2 previous vein grafts were anastomosed to the prosthesis. The patient was successfully liberated from the heart-lung machine and exhibited favorable cardiac function in the postoperative period. Conclusions: Initial peripheral cannulation with a half dose of heparin provides a relatively bloodless and secure re-entry sternotomy. del Nido cardioplegia is easy to implement, is safe, and gives surgeons enough time without interruptions to perform complex procedures.

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“…Significant shortening of the CPB and XC times in the DNC groups compared with CBC was described in most of the analyzed studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] (Table 2). Four studies [18][19][20][21]…”

Section: Cardiopulmonary Bypass and Cross-clamp Timesmentioning

confidence: 99%

Del Nido cardioplegia versus other contemporary solutions for myocardial protection – a literature review

Brzeska¹,

Karolak²,

Żelechowski³

et al. 2023

Eur J Trans Clin Med

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Myocardial protection is one of the most important factors ensuring patient safety during cardiac surgery with the application of cardiopulmonary bypass. Infusion of cardioplegic solution into the coronary circulation protects the heart and provides a standstill operating field for the surgeon. Cold blood cardioplegia and crystalloid cardioplegia are the two main types of solutions with a long history of use and a large amount of research proving their efficacy and safety. Relatively new del Nido cardioplegia seems to be an interesting alternative. We reviewed the literature comparing del Nido cardioplegia with two other types of cardioplegic solutions. We took into consideration many different clinical and biochemical aspects may indicate the quality of cardioprotection.

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Propensity-Matched Analysis of Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery with Prolonged Cross-Clamping Time

Cited by 3 publications

References 21 publications

del Nido versus blood cardioplegia in adult cardiac surgery: a meta-analysis

del Nido versus blood cardioplegia in adult cardiac surgery: a meta-analysis

Type A aortic dissection after Coronary Artery Bypass Grafting

Del Nido cardioplegia versus other contemporary solutions for myocardial protection – a literature review

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