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

Orak, Yavuz; Koçarslan, Aydemir; Boran, Ömer Faruk; Acipayam, Mehmet; Eroğlu, Erdinç; Kirişçi, Mehmet; Doğaner, Adem

doi:10.21470/1678-9741-2019-0436

Cited by 4 publications

(10 citation statements)

References 14 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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…”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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Objective: Although the application of del Nido cardioplegia solution (DNC) in adult cardiac surgery is accumulating, the feasibility and safety of this myocardial protection strategy in adults remains controversial. We aimed to update our previous meta-analysis to determine the myocardial protective effect of DNC versus conventional cardioplegia (CC) in adult cardiac surgery. Methods: A comprehensive literature search was performed using PubMed, EMBASE, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2020. Results: Thirty-seven observational studies and four randomized controlled trials (RCTs) including 21,779 patients were identified. The DNC group was associated with decreased postoperative cardiac enzymes [troponin T (cTnT) and creatine kinase-MB (CK-MB)] [standardized mean differences (SMD): −0.59, 95% confidence interval (CI): −0.99 to −0.19, p = 0.004], cardiopulmonary bypass (CPB) time (MD: −9.31, 95% CI: −13.10 to −5.51, p < 0.00001), aortic cross-clamp (ACC) time (MD: −7.20, 95% CI: −10.31 to −4.09, p < 0.00001), and cardioplegia volume (SMD: −1.95, 95% CI: −2.46 to −1.44, p < 0.00001). Intraoperative defibrillation requirement was less in the DNC group [relative risk (RR): 0.50, 95% CI: 0.33 to 0.75, p = 0.0007]. The pooled analysis revealed no significant difference in operative mortality among the patients assigned to DNC and those undergoing CC. Conclusion: In adult cardiac surgery, compared to CC, myocardial protection used with DNC yield similar or better short-term clinical outcomes. More high-quality trials and RCTs reflecting long-term follow-up morbidity and mortality are required in the future to confirm these findings.

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Section: Resultsmentioning

confidence: 99%

“…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…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“…Although the dNCS has been used in pediatric surgery centers for many years, it has recently been used in adult cardiac surgery as well. The straightforward application of del Nido cardioplegia solution and its long-term effectiveness have increased its use in adult cardiac surgery [20]. In addition, it has been shown to provide 9,300 dollars of cost advantage in 100 cases [21].…”

Section: Del Nido Cardioplegia Solution (Dncs)mentioning

confidence: 99%

“…It can be administered antegradely or retrogradely. Additional doses of the dNCS may be given in patients with aortic insufficiency, hypertrophic hearts, coronary disease and in cases where the effectiveness of the given dose is insufficient [20].…”

Section: Del Nido Cardioplegia Solution (Dncs)mentioning

confidence: 99%

Use of del Nido cardioplegia in adult cardiac surgery

Amaç

Selçuk

BÖLÜKBAŞ

et al. 2022

The European Research Journal

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In most adult cardiac surgery operations, the heart must be completely immobile and isolated from the blood. Therefore, the heart is stopped in diastole and a still operative site is obtained. Cardiac arrest results in ischemiareperfusion injury. For these reasons, myocardial protection and the prevention of damages are required. Various cardioplegia solutions are used for this purpose. It can be said that cardioplegia is the gold standard method of myocardial protection in cardiac arrest. Nowadays, "Single-dose cardioplegia" applications are increasingly used, especially in minimally invasive cardiac surgery and basic coronary bypass procedures due to the advantages they provide, which include reduction of aortic cross-clamp time, prevention of frequent interruption of the procedure due to cardioplegia, and reduced postoperative myocardial dysfunction incidence. The two main solutions used in single dose cardioplegia applications are the Bretschneider solution and the del Nido extracellular cardioplegia solution. The del Nido cardioplegia solution (dNCS), which was originally developed for use in pediatric cardiac surgery, has recently increased its use in adult cardiac surgery due to straightforward application and long-term effectiveness. The del Nido cardioplegia reduces the aortic cross clamp duration, cardiopulmonary bypass time and required cardioplegia solution volume, and is a safer and superior cardioplegia solution and technique in terms of myocardial protection with regards to many organs and cardiacbiochemical parameters.

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Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial

et al. 2021

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IntroductionMyocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study.Methods and analysisThis is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters.Ethics and disseminationThis protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field.Trial registration numberRBR-7g5s66.

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

Cited by 4 publications

References 14 publications

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

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

Use of del Nido cardioplegia in adult cardiac surgery

Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial

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