Modified whole blood microplegia in high‐risk patients

Abstract

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.

Tepid Modified Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery: A PropensityMatched Analysis

“…They found that lidocaine containing cardioplegia may be a safe alternative in adults when administered for the first 60 minutes of ACC. Stamou et al [ 10 ] modified the traditional DNC by removing the crystalloid portion and using whole blood microplegia as the base solution. DNC additives were administered in the whole blood.…”

Whole Blood del Nido versus Cold Blood Microplegia in Adult Cardiac Surgery: A Propensity-Matched Analysis

“…26 We analyzed the cost of this new BDN technique and found the cost of BDN per case to be US$26.50, whereas one dose of traditional del Nido crystalloid solution is US$50.40 and the average cost of Buckberg cardioplegia is US$192.51, which translates to a cost saving of US$23.90 per case compared with del Nido cardioplegia and US $168.61 compared with Buckberg cardioplegia. 5…”

“…The technique of the whole blood microplegia has been previously described. 5 The MPS system pressures are maintained at or below 300 mm Hg. A 300-mL maintenance dose is given 90 minutes after the initial dose.…”

Del Nido cardioplegia: Questions and (some) answers

“…20 More recently, the Quest microplegia system has been used to make micro del Nido cardioplegia, in which the crystalloid component is replaced entirely by blood, and the components of del Nido cardioplegia are administered as additives to whole blood. 21 As with conventional microplegia which has a 66:1 blood to crystalloid ratio, this virtually eliminates hemodilution from cardioplegia administration, and allows for the components of del Nido cardioplegia to be given in whole blood. Further studies including micro del Nido cardioplegia would help to establish its potential benefits.…”