Use of del Nido Cardioplegia for Adult Cardiac Surgery at the Cleveland Clinic: Perfusion Implications

Abstract

Cardiac arrest by cardioplegia provides a reproducible and safe method to induce and maintain electromechanical cardiac quiescence. Techniques of intraoperative myocardial protection are constantly evolving. For the past three decades, modified Buckberg cardioplegia solution has been used for adult cardiac surgery at the Cleveland Clinic. This formulation serves as the crystalloid component, which is delivered 4:1 with oxygenated patient’s blood to crystalloid. Meanwhile, our use of the del Nido cardioplegia solution in adult patients, heretofore primarily used in pediatric cardiac surgical centers, has been increasing over the past several years. Single-dose, cold blood del Nido cardioplegia can be delivered antegrade if the duration of the operation will be limited and if there is no significant coronary artery disease or aortic insufficiency that would limit the distribution of cardioplegia. The addition of del Nido cardioplegia to our cardioplegia armamentarium allows us to customize our myocardial protection strategies for different surgical needs. This article aims to provide information on technical aspects of del Nido cardioplegia in adult cardiac surgery and its use at the Cleveland Clinic in the adult surgical population.

del Nido versus hematic cardioplegia in minimally invasive aortic valve surgery

“…Several studies report that del Nido cardioplegia is safe and effective with non-inferior myocardial protection to conventional whole BloCa solution in isolated CABG, including high-risk patients, valve surgery and aortic replacement, including acute aortic dissection surgery. 2–8 Moreover, in the present analysis, the single dose reduces the peri-operative peak of lactate concentration when the CC times were particularly prolonged and induces lower intraoperative haemodilution (less cardioplegic volume per patient and presence of mannitol) requiring less blood transfusions (Tables 1 and 3). It led to lower glucose alterations and a significant reduction of the need for insuline administration.…”

“…In the last decade, the use of DeNiCa has been progressively extended to adult heart surgery, achieving an increasing evidence of its effects on myocardial protection in this population. 2–4 There is a wide consensus after many observational studies regarding safety of DeNiCa in several surgical procedures in adult cardiac surgery. 4–8 It seems to provide myocardial protection at least equal if not superior to other conventional blood-based cardioplegic solutions.…”

Comparison of Del Nido (a different application) and crystalloid blood cardioplegia on arrhythmia and early results

“…Serious concerns have emerged about the use of DN cardioplegia in coronary artery disease, especially in multivessel patients [ 9 ]. Although retrograde cardioplegia provides an effective solution in patients receiving conventional blood cardioplegia, this causes confusion, as DN cardioplegia is a one-time and antegrade application.…”

“…Del Nido (DN) cardioplegia is considered as cardioplegia solutions protecting myocytes. Although it was first used in pediatric cardiac surgery, studies indicating that it can be used in adult cardiac surgery have increased in the following years [ 2 , 3 ]. The contents of the DN cardioplegic solution are given in Table 1 (with blood cardioplegia).…”

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

“…Cardioplegia is administered to the ostia of the coronary arteries, but eventually, it reaches systemic circulation through the cardiac veins and venous cannula of the CPB circuit. The standard priming volume is 1400-1800 mL [91], and cardioplegia is 1100 mL for a single dose of Del Nido cardioplegia [92]. Gunnar et al [93] demonstrated a significant increase in plasma osmolality after the commencement of CPB (322 ± 17 mOsm/kg).…”