Effect of Del Nido cardioplegia on ventricular arrhythmias after cardiovascular surgery

Abstract

Background Del Nido cardioplegia (DNC) has been proven safe and effective in pediatric patients. However, the use of DNC in adult undergoing cardiovascular surgery lacks support with substantial evidence. This study aimed to evaluate the efficacy of DNC as a cardioplegia of prophylaxis to ventricular arrhythmias associated to cardiovascular surgery in adult patients. Methods This study recruited nine hundred fifty-four patients who underwent cardiopulmonary bypass surgeries in Nanjing Hospital affiliated to Nanjing Medical University between January 2019 and December 2019. Among 954 patients, 324 patients were treated with DNC (DNC group), and 630 patients were treated with St. Thomas cardioplegia (STH group). The incidence of postoperative arrhythmia as well as other cardiovascular events relavant to the surgery were investigated in both groups. Results In DNC group, the incidence of postoperative ventricular arrhythmias was lower (12.4% vs. 17.4%, P = 0.040), and the length of ICU stay was shorter (1.97 ± 1.49 vs. 2.26 ± 1.46, P = 0.004). Multivariate logistic regression demonstrated that the use of DNC helped to reduce the incidence of postoperative ventricular arrhythmias (adjusted odds ratio 0.475, 95% CI 0.266–0.825, P = 0.010). The propensity score-based analysis and subgroup analysis indicated that DNC has the same protecting effects towards myocardial in all kinds of cardiopulmonary bypass surgeries. Conclusions Del Nido cardioplegia may potentially reduce the incidence of postoperative ventricular arrhythmias, shorten the length of ICU stay and improve the overall outcome of the patients undergoing cardiovascular surgery.

Protective Efficacy on Adult Ischemic Myocardium under Bypass: Del Nido vs. St. Thomas Blood Cardioplegia

“…The study by Mick et al 8) reported that in isolated aortic valve surgery, the use of DNC significantly reduced ACC time, CPB time, and operating time, while in isolated mitral valve surgery, the advantages were not found. Although the mean ACC duration may be impacted by the need of reperfusion in conventional cardioplegic solution, 8,13,14,17) consistent with other researches, 2,8,9,12,18,19) except for the volume and frequency of cardioplegia perfusion were obvious less in DNC (P <0.01), statistical significance was not found in either ACC duration or CPB time in our study. This may be related to the fewer inclusion of patients in our study and the surgical approach of median sternotomy, which, comparing with the minimally invasive approach, may reduce the disturbance of repeated perfusion to the surgical process.…”

“…Meanwhile, considering the characteristics of adult myocardium, which is less resistant to ischemia than the immature myocardium, and the coronaries of adult patient are usually diseased, concerns still remain with the safe administration of DNC in adult cardiac surgery. Although some clinical studies have shown positives results, 2,[8][9][10][11][12][13][14] further evidences are required.…”

“…27) Furthermore, the combined delivery of magnesium with lidocaine may provide further protection on ischemic cardiomyocytes by inhibiting the influx of intracellular protons to increase intracellular glycogen utilization and thus to provide more ATP stores during ischemia arrest period. 8,18) The reported positive effects of DNC on arrhythmias included lower incidence of VF during cross-clamping period, 11,21,23,25) lower postoperative AF, 21) higher ratio spontaneous restoration of sinus rhythm, 10,12) and less post ACC release defibrillation requirement. 25) The detailed mechanism for these benefits is not completely clear.…”

“…25) The detailed mechanism for these benefits is not completely clear. Multivariate logistic regression analysis in the study by Shu et al 12) showed that DNC could be an independent protection factor against the incidence of postoperative ventricular arrhythmias. The antiarrhythmic effect of lidocaine contained in DNC may be a factor.…”

“…7) Meanwhile, in response to the requirements of minimally invasive and complex operation in adult cardiac surgery, DNC as an alternative to SBC to protect adult ischemic myocardium attracted much attention in recent years. Although some clinical studies have shown positives results, 2,[8][9][10][11][12][13][14] concerns remain with its safe administration in adults, 15) and further evidences are still required. This study aimed to compare the efficacy of DNC with SBC in adult myocardium protection through related clinical and biochemical variables.…”