A Retrospective Comparative Study of Del Nido Versus Intermittent St Thomas Hospital Blood Cardioplegia Solutions in Aortic-Mitral Double Valve Replacement

Abstract

Introduction: It is not uncommon in patients, having rheumatic mitral and aortic valve disease, to undergo mitral valve replacement with aortic valve replacement that is, double valve replacement (DVR) operation who often have severe cardiac dysfunction optimized with medical management before surgery. In this retrospective study we investigated 60 such patients, who underwent DVR operation with either conventional cold blood cardioplegia with St Thomas 2 solution (STH), or del Nido cardioplegia (DN) over five years and compared the effects of the two types of cardioplegia during perioperative and postoperative period with simultaneous comparative study between changes of cardiac performances in the patients with larger left ventricle as compared to those with less enlarged ones. Material and methods: For this retrospective study, the data of 60 patients of DVR over five years, in Medical College, Kolkata, India, were retrieved for study. The cases were placed into 2 groups: STH and DN according to cardioplegia used during DVR. Demographic, echocardiographic, and several perioperative and postoperative data of the two groups of patients, were collected. Differences between perioperative behaviour between STH and DN groups and post operative changes in the echocardiographic parameters between predominantly mitral stenosis (MS) and mitral regurgitation (MR) patients, were analyzed. Results: The aortic cross clamp (CC) and cardiopulmonary bypass (CPB) time in both predominant MS and MR patients was shorter in the DN than the STH groups. There was less arrhythmia, less inotropic and ventilator support in the DN group. There was 10% mortality in the series with majority being in the STH and MR predominant patients. Postoperative improvement of LVEF, reduction of LVIDS and LVIDD were also observed in MS predominant in comparison to MR predominant patients after DVR in both STH and DN groups. Conclusion: Use of DN has been found to have a better outcome and survival when compared to STH cardioplegia solution. DVR could reversely remodel depressed hearts with relatively smaller LV volume and restore LV function of relatively smaller LV of predominant MS patients better in comparison to MR predominant patients with relatively dilated hearts.