Lactated Ringer’s as a Base Solution for del Nido Cardioplegia

Abstract

Unavailability of Plasma-Lyte A precludes the utility of traditional del Nido cardioplegia in many countries. This observational study aimed to evaluate myocardial preservation and clinical outcomes when using lactated Ringer’s solution as the base solution for del Nido cardioplegia as compared with our institute’s standard blood cardioplegia strategy. Eighty-nine adult patients underwent cardiac surgery for acquired heart disease from February 2017 to November 2017 either with del Nido cardioplegia (n = 44) or blood cardioplegia (n = 45). Clinical data and outcomes were compared. Patient characteristics were similar between groups. Troponin T release was lower in the del Nido group on postoperative day 1 (.632 [.437, .907] vs. .827 [.599, 1.388] ng/mL; p = .009) and day 2 (.363 [.250, .451] vs. .549 [.340, .897] ng/mL; p = .002). The del Nido group exhibited lower total volume of cardioplegia administered (1,075 [1,000, 1,250] vs. 3,400 [2,700, 3,750] mL; p < .0001), fewer doses (1.6 ± .7 vs. 4.6 ± 1.3; p < .0001), and a decreased incidence of ventricular fibrillation after aortic cross-clamp removal (9.09 vs. 31.11%; p = .01). The del Nido group had shorter intensive care unit stays (2 [1, 2] vs. 3 [2, 4] days; p < .0001), hospital stays (7 [6, 10] vs. 9 [7, 10] days; p = .0002), less vasopressor and inotropic support (1 [1, 1] vs. 1 [1, 2] days; p = .0001), and lower incidence of postoperative atrial fibrillation/flutter (25 vs. 46.7%; p = .033). No mortality occurred and clinical outcomes were similar. The use of traditional del Nido cardioplegia ingredients added to lactated Ringer’s as the base solution provided either similar or superior myocardial protection than our blood cardioplegia strategy depending on the outcome measure analyzed. The use of lactated Ringer’s as a base solution may be an option for centers that do not have access to Plasma-Lyte. Further investigation and follow-up are warranted after this observational study.

del Nido versus blood cardioplegia in adult cardiac surgery: a meta-analysis

“…Supplemental Table 4, http://links.lww.com/JCM/A545 lists the 42 studies ultimately included in this meta-analysis 15–28,30–34,36–40,43,46–48 …”

Comparative study between conventional crystalloid cardioplegic solution with modified del nido cardioplegia in mitral valve regurgitation surgery

“…Unfortunately, the Plasma Lyte used as the basic solution for del Nido cardioplegia is not available in all countries, preventing its use in many cardiac facilities. An observational study by Kantathut et al [18], compared the del Nido cardioplegia technique with the use of Ringer lactate as the base solution for myocardial preservation and clinical results (St. Thomas cardioplegia). The group that had the modified del Nido spent less time in the ICU and the hospital overall, need inotropic support less frequently, and experiencing fewer instances of postoperative fibrillation or flutter.…”

Comparison of Single-Dose Cardioplegia in Valvular Heart Surgery: Lactated Ringer’s-Based del Nido vs. HistidineTryptophan-Ketoglutarate Cardioplegia Solution

“…Myocardial injury, represented by peak postoperative troponin T levels in this study, was similar between cardioplegia protocols. Both del Nido and HTK cardioplegias have been reported to have similar or superior myocardial protection compared to the blood cardioplegia strategy [ 1 , 2 , 3 , 5 , 8 , 11 ] . However, very few studies have a face-to-face comparison between the two cardioplegia protocols.…”

“…Our cardioplegia strategy was to infuse a single dose of 20 mL/kg with a maximum dose of 1,000 mL for patients weighing > 50 kg over 1-2 minutes with a system pressure of 100-200 mmHg. After 90 minutes of aortic cross-clamping time, the need for redosing and the amount of subsequent dose depended on the surgeon’s decision [ 1 , 9 , 10 , 11 ] .…”

“…Recently, del Nido cardioplegia has become more commonly used in adult cardiac surgery. Since Plasma-Lyte™ A (Baxter Healthcare Corporation, Deerfield, Illinois, United States of America), the base solution for del Nido cardioplegia, is unavailable in many countries, our institution has utilized lactated Ringer’s solution as a base solution for del Nido cardioplegia with excellent results compared to our standard blood cardioplegia [ 10 , 11 ] . To evaluate the safety and efficacy of this modified del Nido cardioplegia, we compared the clinical outcomes associated with modified del Nido cardioplegia and HTK cardioplegia in valvular heart surgery.…”