Comparison of del Nido Cardioplegia vs. blood cardioplegia in adult aortic surgery: Is the single-dose cardioplegia technique really advantageous?

Eris, Cuneyt; Engin, Mesut; Erdolu, Burak; AS, Ahmet Kağan

doi:10.1016/j.asjsur.2021.09.032

Cited by 9 publications

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As highlighted by our analysis, different redosing practices have been described in literature providing no unique protocol. Most of the experiences reporting good clinical outcomes with del Nido cardioplegia in longer operation times used a repeated dose at 60 min when crossclamp is expected to exceed 90–100 min with further doses administered every 60 min thereafter 9,41,42,49 . Based on the available evidence, this strategy appeared safe with comparable clinical outcomes and myocardial protection when using del Nido cardioplegia as an alternative to blood cardioplegia or HTK crystalloid solution.…”

Section: Discussionmentioning

confidence: 99%

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

Malvindi

Tian

Bifulco

et al. 2023

Journal of Cardiovascular Medicine

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Malvindi

Tian

Bifulco

et al. 2023

Journal of Cardiovascular Medicine

View full text Add to dashboard Cite

show abstract

“…In clinical practice, previous experiences focusing on adult cardiac surgery with long crossclamp time reported a myocardial protection strategy based on redosing del Nido cardioplegia after 60 minutes from the initial dose and every 60 minutes thereafter. [22][23][24]26,27 Based on the available literature, this strategy appeared safe and effective with comparable clinical outcomes and myocardial protection when using del Nido cardioplegia as an alternative to HTK solution and blood cardioplegia. For long crossclamp time, acceptable results were also reported with a mixed antegrade + retrograde delivery and the administration of a dilute solution -4:1 blood to crystalloid ratio instead of 1:4 blood to crystalloid ratiofor additional doses.…”

Section: Commentmentioning

confidence: 99%

del Nido and Histidine-Tryptophan-Ketoglutarate cardioplegia in minimally invasive mitral valve surgery: A propensity-Match study

et al. 2023

View full text Add to dashboard Cite

Introduction In the last decade, del Nido cardioplegia has been embedded in adult cardiac surgery involving CABG and aortic valve surgical procedures. We reviewed our early experience with del Nido cardioplegia in the setting of minimally invasive mitral valve surgery. Methods Data on 120 consecutive patients operated between 03/2021 and 06/2022 were retrieved from our internal database (infective endocarditis and urgent operations were excluded). Patients were divided into two groups according to the use of Histidine-Tryptophan-Ketoglutarate or del Nido cardioplegia. A propensity match analysis was performed using thirteen preoperative and intraoperative variables. Several intraoperative data and early postoperative outcomes were investigated, including cardiac enzymes (Troponin I HS and CK-MB) measured upon arrival in the Intensive Care Unit (ICU), after 12 hours and everyday thereafter. Results There was no difference in preoperative characteristics and surgical techniques between both unmatched and matched Histidine-Tryptophan-Ketoglutarate and del Nido populations. Patients in the del Nido group received a lower volume of cardioplegia ( p < 0.001) and ultrafiltration during CPB ( p < 0.001). Histidine-Tryptophan-Ketoglutarate was associated with a lower rate of post cross-clamp spontaneous defibrillation ( p < 0.001) and showed a lower level of blood sodium after CPB ( p < 0.001). The release of cardiac enzymes was similar between the two groups ( p = 0.72). There was no difference in terms of postoperative morbidity and 30 day mortality. Conclusions del Nido cardioplegia in the setting of minimally invasive mitral valve surgery seemed safe with acceptable myocardial protection and excellent early outcomes.

show abstract

“…CARDIOPLEGIA SOLUTIONS There are many cardioplegia solutions available. [Lopez-Mendez 2017, Eris 2022, Veres 2015, Commentale 2018] Most surgeons use some type of blood cardioplegia, which is actually blood diluted with cardioplegia (usually in a 4 parts blood to 1 part crystalloid ratio). This strategy of cardioplegia delivery has been called 'mini plegia.'…”

Section: Planning the Timing And Routes For Delivery Of Cardioplegiamentioning

confidence: 99%

Give Me a Shot of Holy Water: Critical Elements in Myocardial Protection during Cardiac Surgery

Tribble

Teman

2022

HSF

View full text Add to dashboard Cite

There is a surprising paucity of information on myocardial protection during cardiac surgery in the popular techniques books on cardiac surgery. For instance, Khonsari’s otherwise superb book, Cardiac Surgery: Safeguards and Pitfalls in Operative Technique, has only three of its 300 pages that address myocardial protection, while Cooley’s book, Techniques in Cardiac Surgery, has none at all. Similarly, the major textbooks of cardiothoracic surgery (Kirklin & Barrett-Boyes, Sabiston & Spencer, and Cohn & Edmunds) all tend to dwell on basic science and pharmacology, while barely addressing the actual techniques and strategies of myocardial protection during cardiac surgical operations. [Khonsari, Cooley, Kouchoukos, Selke, Cohn]

show abstract

Comparison of del Nido Cardioplegia vs. blood cardioplegia in adult aortic surgery: Is the single-dose cardioplegia technique really advantageous?

Cited by 9 publications

References 21 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

del Nido and Histidine-Tryptophan-Ketoglutarate cardioplegia in minimally invasive mitral valve surgery: A propensity-Match study

Give Me a Shot of Holy Water: Critical Elements in Myocardial Protection during Cardiac Surgery

Contact Info

Product

Resources

About