The del Nido cardioplegia in adult cardiac surgery: reinventing myocardial protection?

Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood Cardioplegia: A Systematic Review and Meta-Analysis

“…It is a calciumfree solution and delivered in a ratio of four parts crystalloid to one part blood [3]. Since its initial use in paediatric cardiac surgery, favourable results have been found in patients undergoing adult cardiac surgery [1]. However, the cardioplegia solution was initially developed for myocardial protection in children, in whom the heart is more resistant to ischaemia and in whom the coronaries are not diseased.…”

“…Myocardial protection is essential in cardiac surgery. Of the various methods of myocardial protection, administration of cardioplegia is the most important [1]. Arresting the heart in diastole with hyperkalaemic solutions reduces myocardial oxygen consumption, and allows the surgeon to operate in a still and quiet field [2].…”

“…Arresting the heart in diastole with hyperkalaemic solutions reduces myocardial oxygen consumption, and allows the surgeon to operate in a still and quiet field [2]. Commonly used cardioplegia solutions in adult cardiac surgery are the multidose blood and the single-dose del Nido crystalloid cardioplegia solutions [1].…”

Use of del Nido cardioplegia in adult cardiac surgery

“…Many studies involving cardiac surgeries performed with dNCS report that it is a and superior cardioplegia solution and technique in terms of aortic cross clamp duration, cardiopulmonary bypass time, required cardioplegia solution volume and cardiac and many organ and biochemical parameters [23][24][25]. In a meta-analysis including 5516 patients from 10 randomized controlled studies, including a larger patient and study series, and 13 cohort studies with propensity-score match analysis, authors revealed that dNCS shortened operation times compared to multidose cardioplegia, while decreasing reperfusion-related fibrillation rates, and postoperative cardiac enzyme levels [26].…”

(Del Nido cardioplegia in adult patients)

“…Během posledních desetiletí jsou základními pilíři ochrany myokardu vyprázdnění -unloading -srdce během mimotělního oběhu, hypotermie a zástava srdce pomocí roztoku s vysokým obsahem draslíku. 4 Možnost použití hyperkalemické kardioplegie poprvé uveřejnil D. G. Melrose (1955) v experimentu na psech při použití citrátu draselného. 5 Principem je zde zvýšení membránového potenciálu dodaným roztokem a inaktivace rychlých sodíkových kanálů potřebných ke spuštění akčního potenciálu kardiomyocytů; dochází tak k zástavě srdce v diastole.…”