Comparison of del Nido cardioplegia and St. Thomas Hospital solution – two types of cardioplegia in adult cardiac surgery

Abstract

IntroductionSt. Thomas’ cardioplegic solution No. 2 (ST), although most widely used in adult cardiac surgery, needs to be given at short intervals, causing additional myocardial injury.AimTo determine whether del Nido (DN) cardioplegia, with longer periods of arrest, provides equivalent myocardial protection as compared to ST.Material and methodsThe study population comprised 100 patients who underwent elective coronary artery bypass grafting (CABG) or double valve replacement (DVR) surgery between January 2015 and January 2016. The patients were divided into two groups based on the type of cardioplegia administered during surgery: 1) intermittent ST (ST, n = 50) and 2) DN cardioplegia (DN, n = 50). We compared the aortic cross clamp (CC) and cardiopulmonary bypass (CPB) times, number of intra-operative DC shocks required, and postoperative changes in left ventricular ejection fraction (LVEF) in the two groups.ResultsThe aortic cross clamp and bypass times were shorter with DN (110.15 ±36.84 vs. 133.56 ±35.66 and 158.60 ±39.92 vs. 179.81 ±42.36 min respectively, p < 0.05). Fewer cardioplegia doses were required in the DN group vs. the ST group (1.38 ±0.59 vs. 4.15 ±1.26; p = 0.001), while a single cardioplegia dose was given to 35 DN patients (70%) vs. 0 ST patients (p < 0.001). Postoperative LVEF was better preserved in the DN group.ConclusionsThe use of DN leads to shorter cross clamp and CPB times, reduces cardioplegia dosage, and provides potentially better myocardial protection in terms of LVEF preservation, with a safety profile comparable to ST cardioplegia.

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

“…8,9,18 CC and CPB times and role of preexisting myocardial function: The CC and CPB duration in the present study were, however, longer than those reported in previously published studies about DVR in adult patients. 18 The plausible explanation for this may be preponderance of often deformed calcified valves, slower surgical procedures of using interrupted sutures for valve replacement, chordal 19 and prolongation of CPB. In our series, retrograde perfusion was not routine affair but used only when required due to unfavorable coronary anatomy during antegrade cardioplegic infusion or when the RV diameter was more than 30 mm.…”

“…This finding of ours corroborates those of others. 18,20,24,25 However, defibrillation was required in 8 patients, more in the STH group (n=5) than the DN group (n=3) due to persistent VT or VF with hypotension despite correction of electrolytic abnormalities and anti arrhythmic medications. Inability to prevent mitochondrial calcium (Ca) uniporter, (MCU) by STH, in mediating reperfusion-induced arrhythmias was an explanation for an increased incidence in the STH group.…”

“…The overall mortality was 10% in our series which was higher than reported by others. 18,31 This may have been due to inclusion of more symptomatically sick patients with inherent LV dysfunction with LV dilatation and high PASP for DVR when they were referred for DVR.…”

Del Nido cardioplegia – what is the current evidence?

“…The aortic cross clamp and bypass times were shorter in the del Nido group. In this study the postoperative left ventricular ejection fraction was better preserved in the del Nido group [ 28 ].…”

Comparison of the operative and postoperative effects of del Nido and blood cardioplegia solutions in cardiopulmonary bypass surgery

“…In studies similar to ours, a smaller amount of cardioplegia (mL) were used in DN group [ 10 , 11 ] . In another study, comparing the use of del Nido with that of St. Thomas’ cardioplegic solution, it was shown that del Nido cardioplegia resulted in shorter cross-clamp and CPB times, less cardioplegia used, and better myocardial protection in terms of left ventricular ejection fraction (LVEF) [ 12 ] . The CPB times in our study were shorter for BC group than for DN group, but this difference was not statistically significant.…”