Myocardial protection in cardiac surgery: Del Nido versus blood cardioplegia

George, Gladdy; Varsha, AV; Philip, Madhu Andrew; Vithayathil, Reshma; Srinivasan, Dharini; Princy, F X Sneha; Sahajanandan, Raj

doi:10.4103/aca.aca_153_19

Cited by 11 publications

(12 citation statements)

References 29 publications

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“…In most studies on this subject, it was reported that the duration of ACC and of CPB are shorter in the DNC group [ 1 - 3 , 9 , 10 ] . However, George et al [ 4 ] reported that they did not observe any differences between the groups regarding ACC and CPB durations in their study. Again, Guajardo et al [ 18 ] , Ad et al [ 6 ] , and Timek et al [ 8 ] reported that they found similar ACC duration in both groups.…”

Section: Discussionmentioning

confidence: 70%

“…Studies on mortality and MAE have indicated similar results in the groups using both cardioplegia solutions [ 1 , 2 , 4 , 6 , 7 ] . Ad et al [ 6 ] and Yammine et al [ 7 ] reported similar results in both cardioplegia groups in their studies.…”

Section: Discussionmentioning

confidence: 92%

“…The study by Misra et al [ 1 ] reported that they did not observe a significant difference between the groups in terms of mortality, postoperative left ventricular ejection fraction, acute renal failure, stroke, or low cardiac output syndrome. Again, George et al [ 4 ] reported that they did not observe any difference between the groups in terms of 30-day mortality or postoperative MI. We observed a higher stroke rate in the BC group in our study, but we did not determine any difference between the groups regarding total MAE or mortality.…”

Section: Discussionmentioning

confidence: 99%

“…The cardioplegia strategy may also affect the duration of MV, ICU stay, and hospital stay [ 1 , 4 ] . George et al.…”

Section: Discussionmentioning

confidence: 99%

“…George et al. [ 4 ] reported in a study in which they compared BC and DNC solutions used during valve operations that there was no difference between the groups in terms of duration of MV, duration of ICU stay, or length of hospital stay. Again, Misra et al.…”

Section: Discussionmentioning

confidence: 99%

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Myocardial Protection in Isolated Coronary Artery Bypass Grafting: Del Nido versus Blood Cardioplegia

Özkara¹,

Kayğın²,

Ergün³

et al. 2023

Braz J Cardiovasc Surg

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Introduction Our study aimed to examine the impacts of blood cardioplegia (BC) and del Nido cardioplegia (DNC) solutions - which we used in isolated coronary artery bypass grafting (CABG) - on early mortality and major adverse events (MAE). Methods We retrospectively analyzed 329 consecutive patients who underwent CABG in our clinic between January 2016 and January 2020. Myocardial infarction, reoperation, cardiac tamponade, stroke, renal failure, extracorporeal membrane oxygenation requirement, and cardiopulmonary resuscitation were defined as MAE. The group in which DNC was used was Group D (181 [55%] patients), and the group in which BC was used was Group B (141 [45%] patients). Results No statistically significant difference was determined between the groups regarding age, weight, body surface area, gender, or European System for Cardiac Operative Risk Evaluation score (P=0.615, P=0.560, P=0.934, P=0.365, P=0.955, respectively). Although there was no statistically significant difference between the groups in terms of aortic cross-clamping time (P=0.712), cardiopulmonary bypass duration was longer in Group B (P=0.001). Even though the incidence of stroke was higher in Group B (P=0.030), no statistically significant difference was observed between the groups regarding total incidence of MAE, mortality, mechanical ventilation time, length of stay in the intensive care unit, or length of hospital stay (P=0.153, P=0.130, P=0.689, P=0.710, P=0.613, respectively). Conclusion We found no significant difference in MAE, mortality, duration of mechanical ventilation, intensive care unit stay, or hospital stay between the DNC and BC groups. We believe that both solutions can be used safely for cardiac protection in the adult patient population.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

“…The cardioplegia strategy may also affect the duration of MV, ICU stay, and hospital stay [ 1 , 4 ] . George et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Myocardial Protection in Isolated Coronary Artery Bypass Grafting: Del Nido versus Blood Cardioplegia

Özkara¹,

Kayğın²,

Ergün³

et al. 2023

Braz J Cardiovasc Surg

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Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial

et al. 2021

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IntroductionMyocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study.Methods and analysisThis is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters.Ethics and disseminationThis protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field.Trial registration numberRBR-7g5s66.

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Del nido versus conventional blood cardioplegia in patients with obstructive hypertrophic cardiomyopathy

et al. 2023

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Background Myocardial protection is essential in cardiac surgery with cardiopulmonary bypass The Del Nido cardioplegia which was initially used in pediatric cardiac surgery, has been increasingly used in adult cardiac surgery recently. However, no literature has reported the efficacy of DNC in hypertrophic obstructive cardiomyopathy. Methods This retrospective study involved elective patients who underwent extended surgical myectomy with or without concomitant cardiac surgical procedures between September 2017 and June 2022. Patients were distributed into two groups, the DNC and the CBC group. The primary outcome was high-sensitivity cardiac troponin I (hs-TnI) and creatine kinase-MB (CK-MB) levels at the 0, 1, and 2 postoperative days. The secondary outcomes contained: intraoperative LVEF, return to spontaneous rhythm; postoperative myocardial infarction, worsening or deteriorating of EF, mechanical circulatory support; new-onset atrial fibrillation; mechanical ventilation duration; intensive care unit hours; in-hospital days. Results Fifty-nine patients were included and divided into the CBC ( n = 15) and the DNC group ( n = 44). There was no statistical difference in patients’ demographics and preoperative parameters between the two groups. No in-hospital mortality. The total cardioplegia volume [21.93(18.36,26.07) vs. 25.68(23.17,37.12), p = 0.012] and infusion times [1(1,1) vs. 2(2,3), p = 0.000] were less and the incidence of return to spontaneous rhythm after declamping was higher in the DNC group [97.7% vs. 73.3%, p = 0.013]. Postoperative hs-TnI and CK-MB levels were comparable between the two groups. A longer DNC infusion interval was associated with higher levels of CK-MB on postoperative day 1 and day 2 ( p = 0.009 and p = 0.011, respectively). Conclusions The use of DNC in extended surgical myectomy procedure was as safe and effective as CBC. However, DNC infusion interval over 60 minutes was associated with increased postoperative CK-MB levels.

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Myocardial protection in cardiac surgery: Del Nido versus blood cardioplegia

Cited by 11 publications

References 29 publications

Myocardial Protection in Isolated Coronary Artery Bypass Grafting: Del Nido versus Blood Cardioplegia

Myocardial Protection in Isolated Coronary Artery Bypass Grafting: Del Nido versus Blood Cardioplegia

Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial

Del nido versus conventional blood cardioplegia in patients with obstructive hypertrophic cardiomyopathy

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