Clinical outcomes of single-dose cardioplegia in high-risk coronary bypass

Aims Initially developed for myocardial protection in immature cardiomyocytes, del Nido cardioplegia has been increasingly used over the past decade in adult patients. Our aim is to analyse the results from randomized controlled trials and observational studies comparing early mortality and postoperative troponin release in patients who underwent cardiac surgery using del Nido solution and blood cardioplegia. Methods A literature search was performed through three online databases between January 2010 and August 2022. Clinical studies providing early mortality and/or postoperative troponin evaluation were included. A random-effects meta-analysis with a generalized linear mixed model, incorporating random study effects, was implemented to compare the two groups. Results Forty-two articles were included in the final analysis for a total of 11 832 patients, 5926 of whom received del Nido solution and 5906 received blood cardioplegia. del Nido and blood cardioplegia populations had comparable age, gender distribution, history of hypertension and diabetes mellitus. There was no difference in early mortality between the two groups. There was a trend towards lower 24 h [mean difference −0.20; 95% confidence interval (CI) −0.40 to 0.00; I 2 = 89%; P = 0.056] and lower peak postoperative troponin levels (mean difference −0.10; 95% CI −0.21 to 0.01; I 2 = 0.87; P = 0.087) in the del Nido group. Conclusion del Nido cardioplegia can be safely used in adult cardiac surgery. The use of del Nido solution was associated with similar results in terms of early mortality and postoperative troponin release when compared with blood cardioplegia myocardial protection.

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“…Supplemental Table 4, http://links.lww.com/JCM/A545 lists the 42 studies ultimately included in this meta-analysis 15–28,30–34,36–40,43,46–48 …”

Section: Resultsmentioning

confidence: 99%

“…The PRISMA search flow diagram and checklist are available in Supplemental Figure 1 Supplemental Table 4, http://links.lww.com/JCM/A545 lists the 42 studies ultimately included in this meta-analysis. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][30][31][32][33][34][36][37][38][39][40]43,[46][47][48]…”

Section: Study Selectionmentioning

confidence: 99%

del Nido versus blood cardioplegia in adult cardiac surgery: a meta-analysis

Malvindi

Tian

Bifulco

et al. 2023

Journal of Cardiovascular Medicine

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“…19,20 However, we did not notice any difference in favor of blood cardioplegia in our cohort, which is a similar finding to other reports on using the del Nido protocol in high-risk cases. 21,22…”

Section: Discussionmentioning

confidence: 99%

Determinants of Inadequate Cardioprotection in Adult Patients with Left Ventricular Dysfunction

Sanetra

Gerber

Buszman

et al. 2023

Thorac Cardiovasc Surg

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Background: Perioperative cardioprotection is essential for achieving satisfactory clinical outcomes in heart failure patients. It is important to understanding the factors affecting perioperative cardioprotection. Methods: The institutional database was searched for patients with reduced ejection fraction (EF, < 40%) who underwent surgery with cardioplegia-induced arrest. Patients were divided into del Nido cardioplegia (DN) and cold blood cardioplegia (CB) groups. The relationships between age, preoperative blood parameters, creatinine, cross-clamp time (CCT), extracorporeal circulation time (ECT), and postoperative troponin values at 12 h or deterioration of EF (≥ 5%) were evaluated. Baseline characteristics, operative parameters, and outcomes were analyzed. Results: There were 508 patients with reduced EF (331 DN and 177 CB). In the entire cohort, anaemic patients had greater troponin values (p = 0.004), as well as in the DN group (p = 0.002). However, this was not detected in the CB group (flat regression line; p = 0.674). Patients with high leukocyte values had greater troponin release (entire cohort: p < 0.001; DN group: p < 0.001; CB group: steep regression line with p = 0.042). Longer CCT and ECT were associated with greater troponin release (entire cohort; both groups) and greater risk of fall in EF. In a direct comparison, fewer patients had significant deterioration of EF in the DN group than CB group (3.9% vs 11.9%; p < 0.001). Conclusions: The use of CB cardioplegia may be beneficial in anaemic patients, while the use of DN cardioplegia may be beneficial for expected long CCT and high leucocytosis.

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“…It has also been reported that del Nido cardioplegia had higher expression of inflammatory response and higher biomarker values in high-risk coronary artery bypass grafting procedures. 26 Those patients, however, present with completely different clinical profile and results cannot be directly compared to valvular procedures. This matter surely requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

One-shot cardioplegia for minimally invasive mitral valve repair-a comparison of del Nido and Bretschneider Histidine-Tryptophan-Ketoglutarate solutions

et al. 2022

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Background Minimally invasive procedures are demanding in terms of cardioprotection. In many leading centres Bretschneider HTK solution is used for mitral valve surgery. The study was designed to provide comparison of the del Nido and Bretschneider HTK protocol. Methods Patients who underwent minimally invasive mitral valve repair for primary mitral regurgitation and received single delivery of either del Nido (Group 1) or Bretschneider HTK cardioplegia (Group 2) were matched on basis of age, gender and length of the cross-clamp time. The groups were compared in terms of major adverse cardiac and cerebrovascular events (death, myocardial infarction, stroke), high sensitivity troponin T (hs-TnT) and creatine kinase- MB isoenzyme (CK-MB) release at 12 h and 24 h following the surgery, incidence of low cardiac output syndrome (LCOS), postoperative arrhythmia, transfusions and postoperative renal function. Results Case control matching selected 38 pairs of patients. None of patients died, nor suffered from myocardial infarction or stroke. Troponin values did not differ at 12 h (median: 281.0 pg/mL vs 313.0 pg/mL; p = .38) and 24 h (median: 261.0 pg/mL vs 299.0 pg/mL; p = .54), as well as CK-MB at 12 h (median: 25.0 ng/mL vs 29.0 ng/mL; p = .31) and 24 h (median: 11.0 ng/mL versus 9.6 ng/mL; p = .46). Difference in occurrence of LCOS was insignificant (2 vs 7; 5.2% vs 18.4%; p =.15). No difference was shown in incidence of postoperative arrhythmia, transfusions and renal function. Conclusions Del Nido cardioplegia can be used safely as an alternative for Bretschneider HTK for minimally invasive mitral valve surgery.

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Clinical outcomes of single-dose cardioplegia in high-risk coronary bypass

Cited by 8 publications

References 18 publications

del Nido versus blood cardioplegia in adult cardiac surgery: a meta-analysis

del Nido versus blood cardioplegia in adult cardiac surgery: a meta-analysis

Determinants of Inadequate Cardioprotection in Adult Patients with Left Ventricular Dysfunction

One-shot cardioplegia for minimally invasive mitral valve repair-a comparison of del Nido and Bretschneider Histidine-Tryptophan-Ketoglutarate solutions

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