Comparison of del Nido Cardioplegia and Blood Cardioplegia in Aortic Root Surgery

Abstract

<jats:p>Aim: To compare del Nido cardioplegia (DNC) with conventional blood cardioplegia (BC) in aortic root surgery. Methods: Subjects who underwent aortic root surgery during a 3-year period were included. A DNC group was compared with a matched BC group. Results: A total of 72 subjects were included, 36 who underwent DNC compared with 36 propensity-matched subjects who underwent BC. Fifty-one (70.8%) were male, and 21 (29.2%) were female, with a mean age of 66.19 ± 7.02 years (range 51 to 81). No significant differences in baseline characteristics, preoperative echocardiogram parameters, or intraoperative parameters were found between the groups. For DNC versus BC, cardiopulmonary bypass time, aortic clamp time, cardioplegia volume (all P = .001), and defibrillation (P = .007) were significantly lower. For postoperative biochemical parameters, creatinine levels at hour 24, potassium levels at hours 1 and 24, and glucose levels at hours 6 and 24 did not differ between the groups (P &gt; .05). Creatine kinase-MB and troponin T levels at hours 1 and 24 were significantly lower in DNC versus BC (all P = .001). Hematocrit levels at hours 6 and 24 were significantly higher in DNC (P = .001). The groups did not differ in terms of postoperative inotropic support, postoperative complications, intubation period, or duration of intensive care unit stay (P &gt; .05). Although the need for thrombocyte transfusion did not differ between groups (P &gt; .05), DNC resulted in less use of erythrocyte and fresh frozen plasma transfusions (both P = .001). Postoperative ejection fraction was significantly better in the DNC group than in the BC group (P = .006). Conclusion: The results indicate better intraoperative parameters and better ejection fraction rates with DNC than with BC. DNC is an effective and safe alternative to blood cardioplegia for aortic root surgery.</jats:p>

Del Nido cardioplegia for myocardial protection in adult cardiac surgery: a systematic review and update meta-analysis

“…Forty-one studies regarding DNC versus CC for myocardial protection used in adult cardiac surgery were included in the final analysis. 7,8,20–58 On the basis of 9 retrospective observational studies we had previously included, another 32 studies published after September 2016 were included. Four of these studies were randomized controlled trials (RCTs), 24,36,39,43 one was a prospective observational study 20 while the rest were retrospective observational studies.…”

“…Thirty-eight and 39 studies respectively involving 21,391 and 21,595 patients reported CPB 7,8,20–31,33,35–42,44–58 and ACC time. 7,8,20–33,35–42,44…”

“…Twenty-four 7,8,21–24,26,28,29,33,36,38,39,41,42,44,48,50,52–55,57,58 and 13 studies 8,23,36,37,39,42–44,51–53,55,56 respectively presented the incidences of atrial fibrillation and myocardial infarction, including 5289 and 1504 patients. The use of DNC was not associated with an increased incidence of atrial fibrillation (RR: 1.02, 95% CI: 0.87 to 1.19, p = 0.83, see Supplemental Figure 3C) or myocardial infarction (RR: 1.14, 95% CI: 0.83 to 1.56, p = 0.41, see Supplemental Figure 3D).…”

“…A total of 23 studies involving 3676 patients reported the ICU stay time. 7,8,21,23–28,35,37,39,41,42,44,48,50,51,53–57 The duration of hospital stay was recorded in 22 studies involving 3918 patients, 7,8,23,24,26–28,33,35–37,39,41,42,44,48,51,53–57 whereas operative mortality was reported in 37 studies. 7,8,20–28,30–39,41…”

“…7,8,21,23–28,35,37,39,41,42,44,48,50,51,53–57 The duration of hospital stay was recorded in 22 studies involving 3918 patients, 7,8,23,24,26–28,33,35–37,39,41,42,44,48,51,53–57 whereas operative mortality was reported in 37 studies. 7,8,20–28,30–39,41…”