Comparison of Del Nido and Blood Cardioplegia in Pediatric Patients Undergoing Surgical Repair for Congenital Heart Disease

Işıldak, Fatma Ukil; Yavuz, Yasemin

doi:10.1007/s00246-021-02623-z

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…In the same study, it was The Cardiovascular Thoracic Anaesthesia and Intensive Care Society reported that no mortality was observed. [21] Similarly, in a study conducted with adult patients, it was reported that the duration of intubation was significantly longer in the DN group, but the blood and DN cardioplegia groups were similar in terms of ICU and hospital LOS. [23] Panigrahi et al [20] reported that mechanical ventilation, and ICU and hospital LOS were similar in the conventional blood and DN cardioplegia groups in pediatric cardiac surgery.…”

Section: Discussionmentioning

confidence: 88%

“…[20] Therefore, it is expected that the ACC and CPB times will be shorter and the needed inotropic support will be less in patients undergoing DN cardioplegia. In the study of Işıldak et al, [21] it was reported that DN cardioplegia provided shorter ACC and CPB times and lower post-operative VIS compared with blood cardioplegia in pediatric patients undergoing surgical repair for CHD. Rushel et al [22] reported that DN cardioplegia was associated with reduced CPB and ACC times during tetralogy of Fallot repair.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Effect of Del Nido and Cold Blood Cardioplegia on Renal Functions in the Surgery of Congenital Heart Diseases

Işıldak¹

2022

GKDA Derg

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Objectives:We aimed to evaluate the effect of del Nido (DN) and cold blood (CB) cardioplegia on renal functions in children undergoing cardiac surgery for congenital heart disease (CHD). Methods: This study was conducted prospectively. One hundred and nineteen pediatric patients with Risk Adjustment for Congenital Heart Surgery (RACHS) scores below 3 were randomly assigned using allocation software to two groups (CB and DN cardioplegia) according to the type of cardioplegia solution used. The change of urea, creatinine, estimated glomerular filtration rate (eGFR), and renal near-infrared spectroscopy (NIRS) values before and after cardioplegia were the primary outcome measures of this study. Results: Cardiopulmonary bypass (CPB) duration (p<0.001), ACC duration (p<0.001), and extubation time (p=0.032) were longer and the VIS-48th h (p=0.048) value was higher in the DN group. The pre-operative versus 48th h increase in urea were higher in the DN group (p=0.028). The increase in CPB duration was predictive for the increase in urea (p=0.009) and creatinine (p=0.004), and younger age was a predictor for the increase in urea (p=0.014) and decrease in eGFR (p=0.044). Conclusion:Although CPB duration, aortic cross-clamp times, and extubation times are longer in DN cardioplegia recipients, it is as safe as blood cardioplegia in terms of ICU LOS, mortality rates, VIS-initial and VIS-24th h values, and changing renal NIRS, creatinine, eGFR, and urea values during surgery. There is a need for more extensive research on the use of DN cardioplegia in CHD surgery.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Evaluation of the Effect of Del Nido and Cold Blood Cardioplegia on Renal Functions in the Surgery of Congenital Heart Diseases

Işıldak¹

2022

GKDA Derg

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“…Evidence suggests that one dose of del Nido is sufficient for an aortic cross-clamp duration of over 90 min, while a longer period would require an additional dose. Previous research suggests shorter aortic cross-clamp times, as well as reduced or similar levels of markers of myocardial injury, after del Nido compared to those in blood cardioplegia pediatric patients [ 66 , 73 , 74 ]. A recent cohort study from 2022 also confirmed the advantage of del Nido solution over ST blood cardioplegia in terms of the decrease in the aortic cross-clamp time and number of doses, but in neonates [ 75 ].…”

Section: How Adjuncts In Cardioplegic Solutions Affect the Extent Of ...mentioning

confidence: 99%

Cardioplegia in Open Heart Surgery: Age Matters

Bradić

Andjić

Jeremić

et al. 2023

JCM

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Introduction: Cardioplegia is a pharmacological approach essential for the protection of the heart from ischemia–reperfusion (I–R) injury. Over the years, numerous cardioplegic solutions have been developed, with each cardioplegic approach having its advantages and disadvantages. Cardioplegic solutions can be divided into crystalloid and blood cardioplegic solutions, and an experienced surgeon chooses the type of solution based on the individual needs of patients in order to provide optimal heart protection. Importantly, the pediatric immature myocardium is structurally, physiologically, and metabolically different from the adult heart, and consequently its needs to achieve cardioplegic arrest strongly differ. Therefore, the present review aimed to provide a summary of the cardioplegic solutions available to pediatric patients with a special focus on emphasizing differences in heart injury after various cardioplegic solutions, the dosing strategies, and regimens. Material and methods: The PubMed database was searched using the terms cardioplegia, I–R, and pediatric population, and studies that investigated the influence of cardioplegic strategies on markers of cardiac muscle damage were further analyzed in this review. Conclusions: A large body of evidence suggested more prominent benefits achieved with blood compared to those with crystalloid cardioplegia in pediatric myocardium preservation. However, standardized and uniform protocols have not been established so far, and an experienced surgeon chooses the type of cardioplegia solution based on the individual needs of patients, while the severity of myocardial damage strongly depends on the type and duration of the surgical procedure, overall patient condition, and presence of comorbidities, etc.

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“…Delivery of del Nido solution was administered in a 1:4 ratio of blood to crystalloid [ 6 ]. In the past few decades, del Nido cardioplegia has been widely used for intraoperative myocardial protection of congenital heart disease [ 7 ]. Based on pediatric usage experience, del Nido was quickly applied to adult cardiac surgery for cardiac protection.…”

Section: Introductionmentioning

confidence: 99%

Del Nido cardioplegia versus cold blood cardioplegia in adult cardiac surgery: a meta-analysis of randomized clinical trials

Li,

Xiang,

Yang

et al. 2024

J Cardiothorac Surg

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Objective Systematic evaluation of the safety of del Nido cardioplegia compared to cold blood cardioplegia in adult cardiac surgery. Methods We systematically searched PubMed, EMbase, The Cochrane Library and ClinicalTrials.gov for randomized clinical trials (published by 14 January 2024) comparing del Nido cardioplegia to cold blood cardioplegia in adult. Our main endpoints were myocardial injury markers and clinical outcomes. We assessed pooled data by use of a random-effects model or a fixed-effects model. Results A total of 10 studies were identified, incorporating 889 patients who received del Nido cardioplegia and 907 patients who received cold blood cardioplegia. The meta-analysis results showed that compared with the cold blood cardioplegia, the del Nido cardioplegia had less volume of cardioplegia, higher rate of spontaneous rhythm recovery after cross clamp release, lower levels of postoperative cardiac troponin T and creatinine kinase-myocardial band, all of which were statistically significant. However, there was no statistically significant difference in postoperative troponin I and postoperative left ventricular ejection fraction. The clinical outcomes including mechanical ventilation time, intensive care unit stay time, hospital stay time, postoperative stroke, postoperative new-onset atrial fibrillation, postoperative heart failure requiring intra-aortic balloon pump mechanical circulation support, and in-hospital mortality of both are comparable. Conclusion Existing evidence suggests that del Nido cardioplegia reduced volume of cardioplegia administration and attempts of defibrillation. The superior postoperative results in CTnT and CK-MB may provide a direction for further research on improvement of the composition of cardioplegia. Visual Abstract

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Comparison of Del Nido and Blood Cardioplegia in Pediatric Patients Undergoing Surgical Repair for Congenital Heart Disease

Cited by 4 publications

References 18 publications

Evaluation of the Effect of Del Nido and Cold Blood Cardioplegia on Renal Functions in the Surgery of Congenital Heart Diseases

Evaluation of the Effect of Del Nido and Cold Blood Cardioplegia on Renal Functions in the Surgery of Congenital Heart Diseases

Cardioplegia in Open Heart Surgery: Age Matters

Del Nido cardioplegia versus cold blood cardioplegia in adult cardiac surgery: a meta-analysis of randomized clinical trials

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