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Outcomes of del Nido cardioplegia after surgical aortic valve replacement and coronary artery bypass grafting

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Abstract

Objective

The use of del Nido cardioplegia (DNC) was initially adopted in the field of pediatric cardiac surgery. Several studies in adult patients suggested there were no differences in early postoperative outcomes as compared to blood-based cardioplegia. We sought to evaluate the impact of DNC as compared to modified Buckberg cardioplegia (BC) on early postoperative outcomes in patients undergoing surgical aortic valve replacement with and without coronary artery bypass grafting (SAVR ± CABG).

Methods

All SAVR ± CABG procedures were switched from BC to DNC at our institute in 2012. We compared outcomes of BC (November 2007–October 2012; n = 1037) with DNC (November 2012–December 2017; n = 1067). Significant baseline differences were observed between the two groups and such differences were adjusted via inverse propensity treatment weighting.

Results

After adjustment, SAVR ± CABG patients who received DNC required longer aortic cross-clamp times, while postoperative peak troponin I and creatinine kinase-MB isotype were significantly lower in the BC group. Length of hospital and intensive care unit stay were significantly shorter in the DNC group. The incidence of postoperative complications was lower in the DNC cohort. Thirty-day mortality rate was significantly lower in the DNC group (3.0% vs 4.9%, p = 0.002).

Conclusions

The use of DNC cardioplegia in our cohort of adult patients who underwent SAVR ± CABG was safe and associated with improved postoperative outcomes. However, the use of DNC may be associated with higher degrees of myocardial injury.

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Data availability

This study design was approved by Institutional Review Board (IRB). There was a waiver of consent and patients did not need to consent to use their data.

References

  1. Timek T, Willekes C, Hulme O, Himelhoch B, Nadeau D, Borgman A, et al. Propensity matched analysis of del Nido Cardioplegia in adult coronary artery bypass grafting: initial experience with 100 consecutive patients. Ann Thorac Surg. 2016;101(6):2237–41.

    Article  PubMed  Google Scholar 

  2. Lenoir M, Bouhout I, Jelassi A, Cartier R, Poirier N, El-Hamamsy I, et al. Del Nido cardioplegia versus blood cardioplegia in adult aortic root surgery. J Thorac Cardiovasc Surg. 2021;162(2):514-22.e2.

    Article  PubMed  Google Scholar 

  3. Mick SL, Robich MP, Houghtaling PL, Gillinov AM, Soltesz EG, Johnston DR, et al. del Nido versus Buckberg cardioplegia in adult isolated valve surgery. J Thorac Cardiovasc Surg. 2015;149(2):626–34.

    Article  PubMed  Google Scholar 

  4. Kim K, Ball C, Grady P, Mick S. Use of del Nido Cardioplegia for adult cardiac surgery at the cleveland clinic: perfusion implications. J Extra Corpor Technol. 2014;46(4):317–23.

    Article  PubMed  PubMed Central  Google Scholar 

  5. O’Donnell C, Wang H, Tran P, Miller S, Shuttleworth P, Boyd JH. Utilization of del Nido Cardioplegia in adult coronary artery bypass grafting—a retrospective analysis. Circ J. 2019;83(2):342–6.

    Article  CAS  PubMed  Google Scholar 

  6. Valooran GJ, Nair SK, Chandrasekharan K, Simon R, Dominic C. del Nido cardioplegia in adult cardiac surgery—scopes and concerns. Perfusion. 2016;31(1):6–14.

    Article  PubMed  Google Scholar 

  7. Sanetra K, Pawlak I, Cisowski M. Del Nido cardioplegia—what is the current evidence? Kardiochir Torakochirugia Pol. 2018;15(2):114–8.

    Google Scholar 

  8. Li Y, Lin H, Zhao Y, Li Z, Liu D, Wu X, et al. Del Nido Cardioplegia for myocardial protection in adult cardiac surgery: a systematic review and meta-analysis. ASAIO J. 2018;64(3):360–7.

    Article  PubMed  Google Scholar 

  9. Yerebakan H, Sorabella RA, Najjar M, Castillero E, Mongero L, Beck J, et al. Del Nido Cardioplegia can be safely administered in high-risk coronary artery grafting surgery after acute myocardial infarction: a propensity matched comparison. J Cardiothorac Surg. 2014;9:141.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Matte GS, del Nido PJ. History and use of del Nido cardioplegia solution at Boston Children’s Hospital. J Extra Corpor Technol. 2012;44(3):98–103.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sorabella RA, Akashi H, Yerebakan H, Najjar M, Mannan A, Williams MR, et al. Myocardial protection using del Nido Cardioplegia solution in adult reoperative aortic valve surgery. J Card Surg. 2014;29(4):445–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hamad R, Nguyen A, Laliberté É, Bouchard D, Lamarche Y, El-Hamamsy I, et al. Comparison of del Nido Cardioplegia with blood Cardioplegia in adult combined surgery. Innovations (Phila). 2017;12(5):356–62.

    Article  PubMed  Google Scholar 

  13. Cayir M, Yuksel A. The use of del Nido Cardioplegia for myocardial protection in isolated coronary artery bypass surgery. Heart Lung Circ. 2020;29(2):301–7.

    Article  PubMed  Google Scholar 

  14. Yammine M, Neely RC, Loberman D, Rajab TK, Grewal A, McGurk S, et al. The use of lidocaine containing Cardioplegia in surgery for adult acquired heart disease. J Card Surg. 2015;30(9):677–84.

    Article  PubMed  Google Scholar 

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Division of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA

    Chikashi Nakai, Cheng Zhang, Hiroto Kitahara, Christian Shults & Ezequiel. J. .Molina

  2. Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA

    Ron Waksman

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  1. Chikashi Nakai
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  2. Cheng Zhang
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  3. Hiroto Kitahara
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  4. Christian Shults
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  5. Ron Waksman
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  6. Ezequiel. J. .Molina
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Correspondence to Chikashi Nakai.

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Nakai, C., Zhang, C., Kitahara, H. et al. Outcomes of del Nido cardioplegia after surgical aortic valve replacement and coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 71, 491–497 (2023). https://doi.org/10.1007/s11748-023-01914-x

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  • DOI: https://doi.org/10.1007/s11748-023-01914-x

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