Comparison of del Nido Cardioplegia with Blood Cardioplegia in Coronary Artery Bypass Grafting Combined with Mitral Valve Replacement

Abstract

ObjectiveTo compare del Nido cardioplegia (DNC) with blood cardioplegia (BC) in coronary artery bypass grafting (CABG) combined with mitral valve replacement.MethodsA 3-year single-center retrospective cohort study was carried out. Subjects who underwent CABG (up to triple bypass) combined with mitral valve replacement were divided into DNC and BC groups. Each group had thirty subjects.ResultsBoth groups demonstrated similar baseline characteristics, including age, gender, cardiac/non-cardiac comorbidity, and preoperative echocardiographic parameters. Compared with the BC group, the DNC group demonstrated significantly lower cardioplegia volume (BC = 1130.00±194.1 mL, DNC = 884.33±156.8 mL, P=0.001), cardiopulmonary bypass time (DNC = 110.90±12.52 min, BC = 121.70±13.57 min, P=0.002), aortic clamp time (DNC = 91.37±11.58 min, BC = 101.37±13.87 min, P=0.004), and need for intraoperative defibrillation (DNC = 6 events, BC = 21 events, P=0.001). Postoperative creatine kinase-MB levels and troponin levels were significantly lower in the DNC group than in the BC group. Postoperative haemoglobin and haematocrit levels were significantly higher in the DNC group than in the BC group. The intubation period (hours) in intensive care unit (ICU) was significantly small in the BC group (DNC = 8.13±12.21, BC = 6.82±1.57, P=0.037); however, ICU stay, total hospital stay, and postoperative complication rates were not significantly different between them. At pre-discharge echocardiography, the DNC group demonstrated significantly higher ejection fraction rates than the BC group (47.79±5.50 and 45.72±5.86, respectively, P=0.005).ConclusionDNC presented better intraoperative and postoperative parameters and it is an effective and safe alternative to BC for CABG combined with mitral valve replacement.

Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood Cardioplegia: A Systematic Review and Meta-Analysis

“…Twenty-nine (29) studies were included in this systematic review and meta-analysis: three RCTs [4,14,15], two prospective observational non-randomised studies [16,17], 16 PMCS [7,8,[18][19][20][21][22][23][24][25][26][27][28][29][30][31], and eight unmatched retrospective cohort studies [5,6,[32][33][34][35][36][37] (Table 1). The majority of the studies used blood cardioplegia in a ratio of 4:1 (blood:crystalloid), with one study using an 8:1 ratio [29], and another study using only blood [4].…”

Single-Dose Del Nido Cardioplegia vs. Blood Cardioplegia in Aortic Valve Replacement Surgery

“…In our study, no significant difference was observed between the two groups in CK-MB or troponin I levels at any period. Although previous studies reported the positive effects of DNC in increasing troponin I levels, most of them included operations requiring myocardial resection (such as mitral valve replacement), which makes it difficult to evaluate the results homogenously 21 - 23 . A recent meta-analysis has revealed that spontaneous defibrillation is associated with the use of DNC 24 .…”

DelNido cardioplegia versus St Thomas cardioplegia solution in double valve replacement: a single centre experience

“…In Del Nido group, fewer patients required DC shocks than in St Thomas cardioplegia group (21.2% vs. 65.9%), this is supported by various other studies across the globe. 25,26 Here, we would like to emphasise on the fact that fibrillation is a common event after clamp removal which can be stabilised by electric defibrillation; however it can also cause myocardial injury. 27…”