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

Abstract

Background and Objectives: Cardioplegia is one of the most significant components used to protect the myocardium during cardiac surgery. There is a paucity of evidence regarding the utilization of whole-blood Del Nido cardioplegia (WB-DNC) on clinical outcomes in coronary artery bypass grafting (CABG). The purpose of this retrospective cross-sectional study is to compare the effectiveness of diluted (blood to crystalloid; 1:4) Del Nido cardioplegia (DNC) with WB-DNC in patients who underwent elective CABG in a tertiary care hospital in Lahore-Pakistan. Materials and Methods: This was a retrospective descriptive study conducted at the Department of Cardiovascular Surgery, King Edward Medical University, Lahore. The medical database of all consecutive patients admitted from January 2018 to March 2020 and who fulfilled the inclusion criteria were reviewed. Results: Out of 471 patients admitted during the study period, 450 underwent various elective cardiac surgeries. Out of 450, 321 patients (71.33%) were operated on for CABG. Only 234/321 (72.89%) CABG patients fulfilled our inclusion criteria; 120 (51.28%) patients received WB-DNC, while 114 (48.71%) patients were administered with DNC. The former group presented with better clinical outcomes compared with the latter in terms of lesser requirements of inotropic support, low degree of hemodilution, shorter in-hospital stay, improved renal function, and cost-effectiveness. Peak values of serum Troponin-T (Trop-T), creatine kinase-myocardial band (CK-MB) release, and activated clotting time (ACT) were also lower in the WB-DNC group compared with the DNC group. Conclusions: The WB-DNC conferred better myocardial protection, improved early clinical outcomes, and also proved to be economical for patients undergoing elective CABG compared with classical crystalloid cardioplegia solution.

Inflammatory Glycoprotein YKL-40 Is Elevated after Coronary Artery Bypass Surgery and Correlates with Leukocyte Chemotaxis and Myocardial Injury, a Pilot Study

“…In our study, CABG procedure increased YKL-40 concentrations nearly 50-fold and the YKL-40 levels correlated positively with myocardial injury. Use of cardioplegia has made CABG surgery safer, but tissue injury can still occur after myocardial perfusion has been re-established [ 1 , 28 ]. The injury can range from slightly impaired myocardial contractility called myocardial stunning to contraction band necrosis and irreversible damage [ 29 ].…”

Effectiveness of Mild to Moderate Hypothermic Cardiopulmonary Bypass on Early Clinical Outcomes

“…All of the cardiac surgeries were performed under general anesthesia using a standard technique, as previously described [ 18 ]. Intraoperative variables such as CPB time, aortic cross-clamp time (ACC), blood hemoglobin concentration, urine output, and cerebral oxygen expenditure (CeO 2 ) were retrieved from the medical database.…”

Open-heart surgery using Del-Nido cardioplegia in two dogs: partial atrioventricular septal defect and mitral repair

“…Del-Nido cardioplegia (DNc) was introduced in neonatal and pediatric cardiac surgery in the early 1990’s [ 5 ]. The long duration (up to 3 h) of a single induction dose results in a decrease in surgical interruption; its use has been applied to adult cardiac surgery and has gained increasing acceptance [ 6 ]. This report presents two successful open-heart surgery cases for the treatment of partial atrioventricular septal defect and severe mitral valve regurgitation in dogs and assesses the usefulness of single-dose DNc.…”