Routine use of del Nido Cardioplegia compared to blood cardioplegia in all types of adult cardiac surgery procedures

Abstract

Background and aim of the study: Several studies reported safety and potential benefits of single dose Del Nido cardioplegia (DNC) in selected Adult Cardiac Surgery (ACS) procedures. However, studies are scarce on routine use of DNC in more complex procedures and patients with high risk profile. We sought to compare DNC with cold blood cardioplegia (BC) in all types of ACS including complex procedures. Methods: Data for 305 consecutive unselected patients who underwent ACS procedures (July/2017 to Nov/2019) were included. DNC was routinely used whenever is available (n=231) and if not available, cold BC is used (n=74). All categories of ACS procedures (primary or redo) were included. Repeated measures analysis was performed to compare baseline, peak and trough Troponins levels in both groups. Linear regression analysis was used to identify independent predictors of peak Troponins level. Results: The two groups were comparable in baseline characteristics including euro score (ES II), risk profile and surgical complexity. DNC was associated with lower cardiopulmonary bypass (CPB) and cross clamp times, cardioplegia volume and number of cardioplegia doses (P<.001). Importantly, DNC was associated with lower postoperative Troponin level (P=.001), shorter duration of inotropic support (P=.02) and shorter intensive care unit stay (P=.04). On linear regression analysis, DNC was an independent predictor of lower postoperative peak Troponin (t =-3.5, P<.001). Conclusions: Routine use of DNC in all types of ACS procedures compared to BC was associated with significantly shorter CPB and clamp times, significantly lower post-operative troponin release and shorter duration of inotropic support.

Del Nido cardioplegia for myocardial protection in adult cardiac surgery: a systematic review and update meta-analysis

“…Twelve studies involving 5065 patients reported on the use of IABP. 22,26–28,30,31,33,36,42,49,55,57 There was no statistically difference between the groups in terms of the incidence of the use of IABP (RR: 1.10, 95% CI: 0.87 to 1.39, p = 0.44, see Supplemental Figure 3A). As many as 17 studies with 3134 patients in total showed the result of postoperative inotropic agent use, 7,21,23,26,28–30,36,41–43,49,54–58 and it was also comparable between the two groups (RR: 1.02, 95% CI: 0.94 to 1.10, p = 0.67, see Supplemental Figure 3B).…”

“…Mechanical ventilation time was reported in 12 studies involving 1849 patients. 7,21,23,28,39,40,42,44,51,54,56,57 The time was found to be significantly less in the DNC group (MD: −0.62, 95% CI: −1.19 to -0.05, p = 0.03, Figure 4(a)). Twelve studies involving 5065 patients reported on the use of IABP.…”

“…Forty-one studies regarding DNC versus CC for myocardial protection used in adult cardiac surgery were included in the final analysis. 7,8,20–58 On the basis of 9 retrospective observational studies we had previously included, another 32 studies published after September 2016 were included. Four of these studies were randomized controlled trials (RCTs), 24,36,39,43 one was a prospective observational study 20 while the rest were retrospective observational studies.…”

“…Thirty-eight and 39 studies respectively involving 21,391 and 21,595 patients reported CPB 7,8,20–31,33,35–42,44–58 and ACC time. 7,8,20–33,35–42,44…”

“…Twenty-four 7,8,21–24,26,28,29,33,36,38,39,41,42,44,48,50,52–55,57,58 and 13 studies 8,23,36,37,39,42–44,51–53,55,56 respectively presented the incidences of atrial fibrillation and myocardial infarction, including 5289 and 1504 patients. The use of DNC was not associated with an increased incidence of atrial fibrillation (RR: 1.02, 95% CI: 0.87 to 1.19, p = 0.83, see Supplemental Figure 3C) or myocardial infarction (RR: 1.14, 95% CI: 0.83 to 1.56, p = 0.41, see Supplemental Figure 3D).…”