del Nido Cardioplegia in Adult Patients: A Propensity-Matched Study of 102 Consecutive Patients

Pragliola, Claudio; Hassan, Essam; Ismail, Huda; Otaibi, Khalid Al; Alfonso, Juan J.; Algarni, Khaled D.

doi:10.1016/j.hlc.2019.08.019

Cited by 9 publications

(13 citation statements)

References 16 publications

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“…Therefore, the bulk of the evidence came from retrospective cohorts. At the time of writing this review, two new studies were indexed in PubMed [40,41]. However, both the studies were PMCS analyses with findings in agreement with this meta-analysis.…”

Section: Strength Of the Meta-analysismentioning

confidence: 67%

Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood Cardioplegia: A Systematic Review and Meta-Analysis

Misra

Srinivasan

Jena

et al. 2021

Heart, Lung and Circulation

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Section: Strength Of the Meta-analysismentioning

confidence: 67%

Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood Cardioplegia: A Systematic Review and Meta-Analysis

Misra

Srinivasan

Jena

et al. 2021

Heart, Lung and Circulation

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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%

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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“…Timek and coworkers found no difference in troponin levels between Del Nido and blood cardioplegia in patients who had isolated CABG, and the levels did not differ in patients older than 75 years, with a left main disease, ejection fraction less than 35%, or STS score more than 2.5% [16]. Other series found significantly lower levels of troponin in patients who received Del Nido [6,7].…”

Section: Discussionmentioning

confidence: 96%

“…Del Nido cardioplegia (Compass-Baxter Healthcare Inc., Edison, NJ, USA) was initially introduced to pediatric cardiac surgery with good outcomes and lower troponin T levels compared to warm blood cardioplegia [4,5]. Del Nido cardioplegia was recently introduced to adult cardiac surgery with encouraging results [6,7]. Del Nido cardioplegia can decrease the operative time because of the single-dose regimen compared to other cardioplegia solutions.…”

Section: Introductionmentioning

confidence: 99%

Del Nido versus warm blood cardioplegia in adult patients with a low ejection fraction

et al. 2021

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Background Del Nido cardioplegia was recently introduced to adult cardiac surgery with encouraging results. The effect of Del Nido cardioplegia in patients with low ejection fraction (EF) has not been thoroughly evaluated. The objective of this study was to assess the safety of Del Nido cardioplegia in adult patients with low EF compared to intermittent warm blood cardioplegia. Results During 2018 and 2019, 73 adult patients with an EF of ≤ 40% underwent cardiac surgery using Del Nido cardioplegia. The patients were compared to a historical cohort of consecutive patients with low EF who had intermitted warm blood cardioplegia (n = 81). Patients who had Del Nido cardioplegia had significantly lower EuroSCORE II (2.73 (1.7–4.1) vs. 4.5 (2.4–7.4), P = 0.004). There were no differences in creatinine clearance and preoperative echocardiographic data between the groups. Cardiopulmonary bypass and cross-clamp times were non-significantly lower with Del Nido cardioplegia. There were no differences in stroke and postoperative echocardiographic data between the groups. No hospital mortality was reported in both groups. Peak troponin levels were significantly higher in patients who had Del Nido cardioplegia (0.88 (0.58–1.47) vs. 0.7 (0.44–1.01) ng/dL; P = 0.01); however, after multivariable regression analysis, cardiopulmonary bypass time was the only predictor of postoperative troponin level (coefficient 0.005 (95% CI: 0.003–0.008); P < 0.001). ICU stay was significantly longer in patients who had Del Nido cardioplegia (4 (3–6) vs. 2(1–4) days, P < 0.001), while postoperative hospital stay did not differ between the groups. After multivariable regression, the use of intermittent warm blood cardioplegia was significantly associated with shorter ICU stay (coefficient − 1.80 (95% CI − 3.06 – -0.55); P = 0.01). Conclusions Prolonged ICU was reported with Del Nido cardioplegia; however, there were no differences in the duration of hospital stay and the clinical outcomes between the groups. Despite the proven efficacy of intermittent warm blood cardioplegia, the use of Del Nido cardioplegia might be safe in patients with low EF.

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del Nido Cardioplegia in Adult Patients: A Propensity-Matched Study of 102 Consecutive Patients

Cited by 9 publications

References 16 publications

Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood Cardioplegia: A Systematic Review and Meta-Analysis

Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood Cardioplegia: A Systematic Review and Meta-Analysis

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

Del Nido versus warm blood cardioplegia in adult patients with a low ejection fraction

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