Single-Dose Del Nido Cardioplegia vs. Blood Cardioplegia in Aortic Valve Replacement Surgery

Abstract

Introduction In this study, we aimed to compare Del Nido cardioplegia (DNC) with blood cardioplegia (BC) in aortic valve replacement. Methods A two-year single-institute retrospective cohort study was accomplished. Subjects who underwent aortic valve replacement surgery were divided into two groups (DNC and BC) and outcomes were compared. Results Preoperative demographics and clinical data of the patients in both groups were similar. The time until cardiac arrest following administration of the first dose of cardioplegia was statistically significantly shorter in the BC group (47.0 sec. 25-103) than in the DNC group (63.0 sec. 48-140) ( P =0.012). Cross-clamping time was longer in the BC group (48.7±12.3 min. vs . 41.5±11.8 min.) ( P =0.041). Cardiopulmonary bypass time was statistically significantly shorter in the DNC group (BC 60.8±18.5 min., DNC 53.7±15.2 min.) ( P =0.046). The rate of postoperative use of intravenous positive inotropic support drugs (dopamine, dobutamine, norepinephrine, etc.) for more than two hours was significantly higher in the BC group (20 [23.5%] in the BC group and nine [17.3%] in the DNC group) ( P =0.035). Creatine kinase myocardial band and troponin I levels were slightly lower in patients receiving DNC, but no statistically significant difference was detected. Conclusion Del Nido cardioplegia is safe and can be used efficiently as an alternative to blood cardioplegia in isolated aortic valve replacement surgery.

Analogy of Del Nido and conventional cardioplegia in patients undergoing isolated mitral valve replacement surgery: A single-center retrospective study

“…The findings of our study are in line with previously conducted study which states that cardiopulmonary bypass time was statistically significantly shorter in the del Nido group and Del Nido cardioplegia is safe and can be used efficiently in isolated valve replacement surgery. [17][18][19] Our study findings are also supported by recently published systematic review and meta-analysis on del Nido versus blood cardioplegia in adult cardiac surgery. 20 A previous study reported that decreased administration for patients receiving the Del Nido cardioplegia 16 which was inconsistent with this study as we found there was no significant statistical association between the type of cardioplegia and the possibility of receiving the RBCs transfusion.…”

Protective Efficacy on Adult Ischemic Myocardium under Bypass: Del Nido vs. St. Thomas Blood Cardioplegia

“…Although statistical difference was not found in the levels of cTn-I, CK-MB, and BNP, the use of DNC demonstrated slightly lower CK-MB (26.40 ± 10.60 vs. 28.07 ± 9.27) cTn-I levels (4.88 ± 2.66 vs. 5.02 ± 2.14). Similar results were found in other contrastive studies, such as Mick et al, 8) Timek et al, 9) and Yerebakan et al 21) in the patients of high-risk CABG; Shi et al 22) in the patients of aortic root disease; Ucak et al 23) and Kim et al 19) in AVR surgery; and Ad et al, 10) Hamad et al, 24) and Kavala et al 25) in adult combined surgery, in which well-preserved LV functions and/or satisfactory postoperative enzyme levels or lower inotropic support in the DNC group were reported. At least, the results in DNC groups were not inferior to that in SBC groups.…”

“…27) Furthermore, the combined delivery of magnesium with lidocaine may provide further protection on ischemic cardiomyocytes by inhibiting the influx of intracellular protons to increase intracellular glycogen utilization and thus to provide more ATP stores during ischemia arrest period. 8,18) The reported positive effects of DNC on arrhythmias included lower incidence of VF during cross-clamping period, 11,21,23,25) lower postoperative AF, 21) higher ratio spontaneous restoration of sinus rhythm, 10,12) and less post ACC release defibrillation requirement. 25) The detailed mechanism for these benefits is not completely clear.…”

Surrogate models provide new insights on metrics based on blood flow for the assessment of left ventricular function

“…Based on preliminary analysis against patient-specific cases, we identify four governing parameters, namely EF , E / A , , , able to embed key information on LV geometry and function. We provide a probabilistic description for the governing parameters by using uniform distributions, with ranges of variation covering both healthy and diseased conditions 15 , 35 – 41 (see Table 1 ). A parameterized geometry, based on the combination of two patient-specific cases and varying only as a function of the governing parameters, is used for the purpose of generating the surrogate models.…”