Safety and Efficacy of Del Nido Cardioplegia Compared with Conventional Blood Cardioplegia in Isolated Coronary Artery Bypass Surgery – A Retrospective Study in a Tertiary Care Academic Centre in Kerala, India

Abstract

BACKGROUND The del Nido cardioplegia was devised and introduced as a single dose cardioplegia for myocardial protection in congenital heart surgery by Petro del Nido and team. The most commonly used cardioplegia in adult cardiac surgery was multidose blood cardioplegia which has to be repeated every 25 to 30 minutes to maintain cardiac arrest. For this, the surgery has to be interrupted leading to prolonged cardiopulmonary bypass and aortic cross clamp time. With promising results of del Nido cardioplegia in adult cardiac surgery, more and more centres adopted this single dose cardioplegia in adult cardiac surgery. We retrospectively analysed the safety and efficacy of del Nido cardioplegia and compared them with those of conventional blood cardioplegia in isolated coronary artery bypass surgery. METHODS We have been using multidose conventional blood cardioplegia (CBCP) solution for all our cardiac surgeries. We changed the cardioplegia protocol to single dose del Nido cardioplegia (DNCP) solution in October 2016. We collected the preoperative, intraoperative and post-operative data of 100 patients in each group, who underwent elective isolated coronary artery bypass surgery. RESULTS The baseline demographic features, pre- and post-operative cardiac function, number of coronary arteries involved, and comorbidities were similar in both groups. There was a statistically significant reduction in cardiopulmonary bypass time (77.16 ± 13.13 minutes vs. 121.69 ± 28.18 minutes, P-value < .00001) and aortic cross clamp time (57.71 ± 10.6 minutes vs. 77.26 ± 20.29 minutes, p value < .00001) in the DNCP group. The total dose of cardioplegia solution required was significantly less in DNCP group (1000 mL vs. 2393.56 ± 592.42 mL, P-value < .00001). The mean post-operative hospital stay in DNCP group was 7.87 ± 1.25 days as compared to 12.49 ± 1.29 days in CBCP group with a P-value < .00001. CONCLUSIONS The del Nido cardioplegia solution is associated with shorter cardiopulmonary bypass and aortic cross clamp time, less volume of cardioplegia solution and shorter mean hospital stay. The del Nido cardioplegia can be used in adult cardiac surgery with the same safety of conventional blood cardioplegia in adult isolated coronary artery bypass surgery. KEYWORDS Del Nido Cardioplegia, Isolated Coronary Artery Bypass Surgery, Myocardial Protection, Cardiopulmonary Bypass Time, Aortic Cross Clamp Time

Safety and efficacy of del Nido cardioplegia in adult cardiac surgery: experience in NICVD

“…Shah et al from Pakistan and Thyagarajan et al from India reported similar findings. 26,27 However George et al from India showed that the CPB and ACC time were not significantly different between the two groups; opposite to our findings. 25 As del Nido cardioplegia is long acting so during operation it was taken less frequently than blood cardioplegia.…”

“…25 As del Nido cardioplegia is long acting so during operation it was taken less frequently than blood cardioplegia. This fact was also supported by Thyagarajan and George et al 25,27 In our study initial haemoglobin levels were significantly lower in del Nido group because of hemo-dilution but the third one was similar. So, more patients of del Nido group required blood transfusion.…”

“…26 However, as mentioned in our study, Thyagarajan et al also showed average post-operative left ventricular ejection fraction (LVEF) and need for prolonged inotropic support were similar in both groups. 27 Although our study found mechanical ventilation time, ICU stay and post-operative hospital stay were significantly lower in del Nido group, George et al showed no significant difference between the two groups regarding these variables. 25 However, Thyagarajan et al and Shah et al in their study mentioned the post-operative hospital stay was significantly lower in del Nido group, similar to our finding.…”

“…61.50±9.83 .33% and 62.27±11.17% respectively (p=0.3301). 27 In another Indian study by George et al these were also similar i.e. 58.8% and 58.5% respectively (p=0.842).…”

“…Other studies in abroad had similar findings. [24][25][26][27] Coronary artery bypass graft (CABG) surgery was the commonest performed procedure of our patients in both groups. It was closely Troponin I Levels of the Two Groups Del Nido Group Blood Cardioplegia Group followed by mitral valve replacement (MVR).…”