Routine use of del Nido cardioplegia compared with blood cardioplegia in all types of adult cardiac surgery procedures

Aims Initially developed for myocardial protection in immature cardiomyocytes, del Nido cardioplegia has been increasingly used over the past decade in adult patients. Our aim is to analyse the results from randomized controlled trials and observational studies comparing early mortality and postoperative troponin release in patients who underwent cardiac surgery using del Nido solution and blood cardioplegia. Methods A literature search was performed through three online databases between January 2010 and August 2022. Clinical studies providing early mortality and/or postoperative troponin evaluation were included. A random-effects meta-analysis with a generalized linear mixed model, incorporating random study effects, was implemented to compare the two groups. Results Forty-two articles were included in the final analysis for a total of 11 832 patients, 5926 of whom received del Nido solution and 5906 received blood cardioplegia. del Nido and blood cardioplegia populations had comparable age, gender distribution, history of hypertension and diabetes mellitus. There was no difference in early mortality between the two groups. There was a trend towards lower 24 h [mean difference −0.20; 95% confidence interval (CI) −0.40 to 0.00; I 2 = 89%; P = 0.056] and lower peak postoperative troponin levels (mean difference −0.10; 95% CI −0.21 to 0.01; I 2 = 0.87; P = 0.087) in the del Nido group. Conclusion del Nido cardioplegia can be safely used in adult cardiac surgery. The use of del Nido solution was associated with similar results in terms of early mortality and postoperative troponin release when compared with blood cardioplegia myocardial protection.

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“…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 …”

Section: Resultsmentioning

confidence: 99%

“…The PRISMA search flow diagram and checklist are available in Supplemental Figure 1 Supplemental Table 4, http://links.lww.com/JCM/A545 lists the 42 studies ultimately included in this meta-analysis. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][30][31][32][33][34][36][37][38][39][40]43,[46][47][48]…”

Section: Study Selectionmentioning

confidence: 99%

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

Malvindi

Tian

Bifulco

et al. 2023

Journal of Cardiovascular Medicine

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“…Significant shortening of the CPB and XC times in the DNC groups compared with CBC was described in most of the analyzed studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] (Table 2). Four studies [18][19][20][21]…”

Section: Cardiopulmonary Bypass and Cross-clamp Timesmentioning

confidence: 86%

Del Nido cardioplegia versus other contemporary solutions for myocardial protection – a literature review

Brzeska¹,

Karolak²,

Żelechowski³

et al. 2023

Eur J Trans Clin Med

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Myocardial protection is one of the most important factors ensuring patient safety during cardiac surgery with the application of cardiopulmonary bypass. Infusion of cardioplegic solution into the coronary circulation protects the heart and provides a standstill operating field for the surgeon. Cold blood cardioplegia and crystalloid cardioplegia are the two main types of solutions with a long history of use and a large amount of research proving their efficacy and safety. Relatively new del Nido cardioplegia seems to be an interesting alternative. We reviewed the literature comparing del Nido cardioplegia with two other types of cardioplegic solutions. We took into consideration many different clinical and biochemical aspects may indicate the quality of cardioprotection.

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“…Timek and coworkers found no difference in troponin levels between Del Nido and blood cardioplegia in patients who had isolated CABG, and the levels did not differ in patients older than 75 years, with a left main disease, ejection fraction less than 35%, or STS score more than 2.5% [16]. Other series found significantly lower levels of troponin in patients who received Del Nido [6,7].…”

Section: Discussionmentioning

confidence: 96%

“…Del Nido cardioplegia (Compass-Baxter Healthcare Inc., Edison, NJ, USA) was initially introduced to pediatric cardiac surgery with good outcomes and lower troponin T levels compared to warm blood cardioplegia [4,5]. Del Nido cardioplegia was recently introduced to adult cardiac surgery with encouraging results [6,7]. Del Nido cardioplegia can decrease the operative time because of the single-dose regimen compared to other cardioplegia solutions.…”

Section: Introductionmentioning

confidence: 99%

Del Nido versus warm blood cardioplegia in adult patients with a low ejection fraction

et al. 2021

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Background Del Nido cardioplegia was recently introduced to adult cardiac surgery with encouraging results. The effect of Del Nido cardioplegia in patients with low ejection fraction (EF) has not been thoroughly evaluated. The objective of this study was to assess the safety of Del Nido cardioplegia in adult patients with low EF compared to intermittent warm blood cardioplegia. Results During 2018 and 2019, 73 adult patients with an EF of ≤ 40% underwent cardiac surgery using Del Nido cardioplegia. The patients were compared to a historical cohort of consecutive patients with low EF who had intermitted warm blood cardioplegia (n = 81). Patients who had Del Nido cardioplegia had significantly lower EuroSCORE II (2.73 (1.7–4.1) vs. 4.5 (2.4–7.4), P = 0.004). There were no differences in creatinine clearance and preoperative echocardiographic data between the groups. Cardiopulmonary bypass and cross-clamp times were non-significantly lower with Del Nido cardioplegia. There were no differences in stroke and postoperative echocardiographic data between the groups. No hospital mortality was reported in both groups. Peak troponin levels were significantly higher in patients who had Del Nido cardioplegia (0.88 (0.58–1.47) vs. 0.7 (0.44–1.01) ng/dL; P = 0.01); however, after multivariable regression analysis, cardiopulmonary bypass time was the only predictor of postoperative troponin level (coefficient 0.005 (95% CI: 0.003–0.008); P < 0.001). ICU stay was significantly longer in patients who had Del Nido cardioplegia (4 (3–6) vs. 2(1–4) days, P < 0.001), while postoperative hospital stay did not differ between the groups. After multivariable regression, the use of intermittent warm blood cardioplegia was significantly associated with shorter ICU stay (coefficient − 1.80 (95% CI − 3.06 – -0.55); P = 0.01). Conclusions Prolonged ICU was reported with Del Nido cardioplegia; however, there were no differences in the duration of hospital stay and the clinical outcomes between the groups. Despite the proven efficacy of intermittent warm blood cardioplegia, the use of Del Nido cardioplegia might be safe in patients with low EF.

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Routine use of del Nido cardioplegia compared with blood cardioplegia in all types of adult cardiac surgery procedures

Cited by 6 publications

References 22 publications

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

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

Del Nido cardioplegia versus other contemporary solutions for myocardial protection – a literature review

Del Nido versus warm blood cardioplegia in adult patients with a low ejection fraction

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