Del Nido Cardioplegia in Coronary Artery Bypass Grafting Surgery: A safe, efficacious and economic alternative to St. Thomas solution; an experience from a developing nation

Abstract

Introduction: del Nido cardioplegia is a newer solution getting popular worldwide, whereas in Nepal, St. Thomas cardioplegia solution is conventionally used. There is no national recommendation on cardioplegia solutions supported by evidences from Nepalese studies. This study aimed to evaluate and compare the efficacy of these solutions in Nepalese patients undergoing coronary artery bypass grafting. Methods: Patients undergoing coronary revascularization, from May 2018 to December 2019, were randomized into St. Thomas and del Nido groups based on the cardioplegia administered, with 45 patients in each group. Preoperative, intraoperative, and postoperative parameters and cost of cardioplegia preparation in the two groups were compared. Results: The cardiopulmonary bypass time (106.13 ± 24.65 minutes vs 107.62 ± 18.69 minutes, p = 0.02), aortic cross clamp time (66.22 ± 15.40 minutes vs 72.07 ± 12.23 minutes, p = 0.04), volume (1059.22 ± 100.30 ml vs 1526.67 ± 271.81 ml, p < 0.001) and number of cardioplegia doses (1.00 ± 0.00 vs 2.51 ± 0.66, p < 0.001) were significantly lower with del Nido cardioplegia. A lower CPK-MB at second post-operative (59.91 ± 31.62 vs 73.82 ± 37.25, p = 0.03) and a higher left ventricle ejection fraction at discharge (56.33 ± 8.94% vs 50.45 ± 8.55%, p < 0.001) was observed in del Nido group. There was one death in St. Thomas group. ICU and hospital stay were similar in both groups. St. Thomas solution was found to be costlier than del Nido solution (USD 5.40 ± 0.96 vs USD 3.50 ± 0.34, p < 0.001). Conclusion: The del Nido cardioplegia was found to be efficacious, safe and more economical alternative to St. Thomas solution.

Del Nido cardioplegia versus other contemporary solutions for myocardial protection – a literature review

“…Significant shortening of the CPB and XC times in the DNC groups compared with CBC was described in most of the analyzed studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] (Table 2). Four studies [18][19][20][21]…”

“…Four [1,6,16,36] studies (including one RCT), all describing different types of cardiac surgeries, showed better echocardiographic parameters in the DNC group measured at different time points during hospitalization. No differences were shown in other studies comparing DNC and CBC (Table 8).…”

Pretreatment with a modified St. Thomas' solution in patients with severe upper limb injuries: Four case reports

“…St. Thomas' solution is a classic myocardial protective solution. Several studies have shown that St. Thomas' solution can reduce myocardial IRI by scavenging oxygen free radicals, inhibiting inflammation and reducing apoptosis to protect the myocardium[ 10 ]. Because St. Thomas' solution can protect the myocardium, our research group adjusted the content of K + to adapt to the internal environment of the skeletal muscle cells and then explored the role of the improved St. Thomas' solution in severe limb injury treatment.…”

Efficacy of Whole-Blood Del Nido Cardioplegia Compared with Diluted Del Nido Cardioplegia in Coronary Artery Bypass Grafting: A Retrospective Monocentric Analysis of Pakistan

“…Recovery from ischemia and functional sustainability of the heart in patients following cardiac surgery using cardiopulmonary bypass (CPB) greatly depends upon better myocardial protection [ 1 ]. Cardioplegia is commonly used to induce and provide a depolarized diastolic cardiac arrest [ 2 ]. In the early 1990s, Del Nido cardioplegia (DNC) formulated for neonatal and pediatric cardiac surgery was introduced [ 3 ] which consists of a calcium-free and potassium-rich non-glucose-based solution with electrolyte composition identical to that of extracellular fluid, and provides longer duration of cardiac arrest [ 4 ].…”