Objectives To compare the safety and efficacy of del-Nido cardioplegia (DNC) with traditional 4:1 cold blood cardioplegia (CBC) in coronary artery bypass grafting and/or valve surgeries in elderly patients. Methods The present study is a retrospective case-series study that included 302 consecutive patients aged 70 years and over who underwent on-pump valve surgery and/or coronary artery bypass graft (CABG). DNC was administered to 90 patients and CBC to 212 patients. After propensity-score matching, 89 pairs were compared. The safety and efficacy were analyzed between the two groups. Results The DNC group had a similar mortality (3.4% vs. 5.6%, OR = 0.79, P = 0.720) and extracorporeal membrane oxygenation (ECMO) implantation rate (1.1% vs. 2.2%, OR = 0.75, P = 1.000) to the CBC group, a lower incidence of postoperative intra-aortic balloon pump (IABP) implantation (1.1% vs. 9.0%, OR = 0.54, P = 0.034) and a higher left ventricular ejection fraction (LVEF) at discharge (60 (56–64) % vs. 57 (51–62)%, P = 0.007). The estimated glomerular filtration rate (eGFR) in the DNC group was higher when the patient was transferred to the intensive care unit (79.4 (65.0-94.3) ml/min/1.73m2 vs. 77.2 (59.8–88.7) ml/min/1.73m2, P = 0.014), but no significant differences were identified after 24 h. The serum lactate values of the DNC group were significantly lower than those of the CBC group (0 h: 2.7 (2.0-3.2) vs. 3.2 (2.4–4.4), P = 0.001; 3 h: 3.2 (2.0-4.8) vs. 4.8 (2.8–6.6), P < 0.001; 6 h: 3.5 (2.2–5.4) vs. 5.8 (3.4–8.4), P < 0.001; 9 h: 3.4 (2.0–7.0) vs. 5.5 (2.9–8.3), P = 0.005). There were no differences between the two groups in respect of lactate levels at 12 h and thereafter. Postoperative creatinine kinase-MB concentrations were similar between the two groups. Conclusions Del-Nido cardioplegia is safe and effective in elderly patients undergoing CABG and/or valve surgery.
OBJECTIVES To compare the safety and efficacy of del-Nido cardioplegia (DNC) with traditional 4:1 cold blood cardioplegia (CBC) in coronary artery bypass grafting and/or valve surgeries in elderly patients. METHODS The present study is a retrospective case-series study that included 302 consecutive patients aged 70 years and over who underwent on-pump valve surgery and/or CABG. DNC was administered to 90 patients and CBC to 212 patients. After propensity-score matching, 89 pairs were compared. The safety and efficacy were analysed between the two groups. RESULTS Compared with the CBC group (2185.8±582.9ml, P<0.001), the volume of infused cardioplegia was less in the DNC group (1423.6±259.5ml). The DNC group had a lower incidence of postoperative intra-aortic balloon pump (IABP) implantation (1.1% vs 9.0%, RR=0.791, P=0.034) and higher left ventricular ejection fraction (LVEF) at discharge (58.5±9.1% vs 55.7±8.6%, P=0.007). The estimated glomerular filtration rate (eGFR) in the DNC group was higher when the patient was transferred to the intensive care unit (78.2±25.1 ml/min/1.73m vs 69.7±20.2 ml/min/1.73m , P=0.021), but no significant differences were identified after 24 hours. The serum lactate values of the DNC group were significantly lower than those of the CBC group (0hrs: 2.8±1.5 vs 3.6±2.0, P=0.001; 3hrs: 3.6±2.7 vs 4.9±2.6, P<0.001; 6hrs: 4.0±3.0 vs 6.1±3.3, P<0.001; 9hrs: 4.4±3.3 vs 5.9±3.6, P=0.004). There were no differences between the two groups in respect of lactate levels at 12 hours and thereafter. Postoperative creatinine kinase-MB concentrations were similar between the two groups. CONCLUSIONS Del-Nido cardioplegia is safe and effective in elderly patients undergoing CABG and/or valve surgery.
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