del Nido versus Buckberg cardioplegia in adult isolated valve surgery

Mick, Stephanie; Robich, Michael P.; Houghtaling, Penny L.; Gillinov, A. Marc; Soltesz, Edward G.; Johnston, Douglas R.; Blackstone, Eugene H.; Sabik, Joseph F.

doi:10.1016/j.jtcvs.2014.10.085

Cited by 136 publications

(166 citation statements)

References 9 publications

(3 reference statements)

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“…Shorter CC and CPB times in the operations utilizing DN were the primary findings apparent from our study, which is consistent with earlier studies using DN in adult patients [5, 7, 8]. This can be attributed to the reduced requirement to administer repeated doses of cardioplegia.…”

Section: Discussionsupporting

confidence: 91%

“…The DN solution has been used successfully in pediatric cardiac surgery [1, 4, 9]; however, its use in adult cardiac surgery has only recently been described [5–8]. The proposed benefit of this solution is the avoidance of the need for repetitive interruption of the procedure to administer multiple doses of standard cardioplegia, which leads to shorter cross clamp times.…”

Section: Discussionmentioning

confidence: 99%

“…The DN’s potential practical advantage is the fact that it provides a long period of arrest before a subsequent dose is needed [4]. Investigators have begun reporting their clinical experiences with DN in adult hearts and have achieved good outcomes with a single dose or longer intervals between doses, leading to shorter cross-clamp times [5–8]. …”

Section: Introductionmentioning

confidence: 99%

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

Mishra

Jadhav

Mohapatra

et al. 2016

kitp

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Mishra

Jadhav

Mohapatra

et al. 2016

kitp

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“…However, it should be noted that these were retrospective, non‐randomized studies. Some studies have found the use of DNC to decrease cardiopulmonary bypass and cross‐clamp times, as well as reduced total operative time . The potential benefits of DNC have also been corroborated in experimental studies.…”

Section: Discussionmentioning

confidence: 89%

Del Nido cardioplegia for minimally invasive aortic valve replacement

et al. 2018

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“…Commonly referred to as “whole blood solution,” this blood and crystalloid formula allows for a longer duration of myocardial arrest. Benefits of the del Nido formula include blocking of calcium flux into the intracellular compartment, reduction of energy expenditure, scavenging of hydrogen ions, preservation of high energy phosphates, and facilitation of anaerobic glycolysis . Recent studies have described the expansion of its use in adult cardiac surgery .…”

Section: Discussionmentioning

confidence: 99%

Modified whole blood microplegia in high‐risk patients

et al. 2019

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Background Numerous studies have documented the safety of whole blood cardioplegia on clinical outcomes after cardiac surgery. However, there is a paucity of studies investigating the outcomes of whole blood microplegia after cardiac surgery. Our protocol of whole blood microplegia includes removal of the crystalloid portion and utilizing the Quest Myocardial Protection System, for delivery of del Nido cardioplegia additives in whole blood. This study sought to evaluate the effects of whole blood microplegia on clinical outcomes, following cardiac surgery, in high‐risk cardiac surgery patients. Methods Between February 2016 and December 2017, 131 high‐risk patients underwent cardiac surgery operations, utilizing whole blood microplegia and were compared with a contemporaneous control group of 236 low‐risk patients. High‐risk patients included those who underwent combined coronary artery bypass grafting (CABG) and valve repair or replacement, double‐valve surgery, triple‐valve repair or replacement, and patients with ejection fraction < 40%. Multivariable logistic regression analysis was performed to identify independent risk factors of mortality after cardiac surgery. Results Operative mortality was 7% for high‐risk and 0% for low‐risk patients (P < 0.001). Of those patients, five had isolated CABG (two had emergent CABG), two had double‐valve surgery, two had combined valve/CABG. In multivariate analysis, high‐risk classification (odds ratio = 3.66, 95% confidence intervals = 1.04‐12.9, P = 0.04), emerged as an independent predictor of operative mortality. Conclusions Whole blood microplegia, is a novel myocardial protection strategy that can be applied in high‐risk cardiac surgery patients and prolonged operations, requiring cardioplegic arrest with acceptable early clinical outcomes.

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del Nido versus Buckberg cardioplegia in adult isolated valve surgery

Abstract: del Nido solution can be used safely and effectively as an alternative to Buckberg solution in adult isolated valve surgery and is associated with lower insulin requirements and potential time and cost savings.

Cited by 136 publications

References 9 publications

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

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

Del Nido cardioplegia for minimally invasive aortic valve replacement

Modified whole blood microplegia in high‐risk patients

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