Transitioning to Del Nido cardioplegia for all-comers: the next switching gear?

Marzouk, Mohamed; Lafrenière-Bessi, Valérie; Dionne, Stéphanie; Simard, Serge; Pigeon, Christian; Dagenais, François; Ad, Niv; Jacques, Frédéric

doi:10.1186/s12872-020-01506-0

Cited by 15 publications

(24 citation statements)

References 25 publications

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“…We noticed that more aortic cross‐clamp time is saved with DNC as the complexity of the procedure increased. Indeed, in a study by Marzouk et al 22 which included all comers similar to our study, they found a significant reduction in aortic cross‐clamp times with DNC with an average of 22 min in favor of DNC (80.8 ± 35.5 vs. 102 ± 31.3, p < .001) which is similar to our findings. Finally, we reported only short‐term outcomes and weather DNC is associated with any potential long‐term benefits is unknown.…”

Section: Limitationssupporting

confidence: 92%

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

Algarni

2020

J Card Surg

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Background and Aim of Study: Several studies reported the safety and potential benefits of single-dose Del Nido cardioplegia (DNC) in selected adult cardiac surgery (ACS) procedures. However, studies are scarce on routine use of DNC in more complex procedures and patients with a high risk profile. We sought to compare DNC with cold blood cardioplegia (BC) in all types of ACS including complex procedures. Methods: Data for 305 consecutive unselected patients who underwent ACS procedures (July/2017 to November/2019) were included. DNC was routinely used whenever is available (n = 231) and if not available, cold BC is used (n = 74). All categories of ACS procedures (primary or redo) were included. Repeated measures analysis was performed to compare baseline, peak, and trough Troponins levels in both groups. Linear regression analysis was used to identify independent predictors of peak Troponins level. Results: The two groups were comparable in baseline characteristics including euro score (ES II), risk profile, and surgical complexity. DNC was associated with lower cardiopulmonary bypass (CPB) and cross-clamp times, cardioplegia volume, and number of cardioplegia doses (p < .001). Importantly, DNC was associated with lower postoperative Troponin level (p = .001), shorter duration of inotropic support (p = .02), and shorter intensive care unit stay (p = .04). On linear regression analysis, DNC was an independent predictor of lower postoperative peak Troponin (t = −3.5, p < .001). Conclusions: Routine use of DNC in all types of ACS procedures compared with BC was associated with significantly shorter CPB and clamp times, significantly lower postoperative troponin release, and shorter duration of inotropic support.

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Section: Limitationssupporting

confidence: 92%

“…We noticed that more aortic cross-clamp time is saved with DNC as the complexity of the procedure increased. Indeed, in a study by Marzouk et al 22 which included all comers similar to our study, they found a significant reduction in aortic cross-clamp times with DNC with an average of 22 min in favor of DNC (80.8 ± 35.5 vs.…”

Section: Limitationssupporting

confidence: 84%

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

Algarni

2020

J Card Surg

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“…Therefore, the bulk of the evidence came from retrospective cohorts. At the time of writing this review, two new studies were indexed in PubMed [40,41]. However, both the studies were PMCS analyses with findings in agreement with this meta-analysis.…”

Section: Strength Of the Meta-analysismentioning

confidence: 69%

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

Misra

Srinivasan

Jena

et al. 2021

Heart, Lung and Circulation

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“…Similar intra operative outcomes were reported in 131 patients receiving Del Nido as compared to blood cardioplegia in combined surgical procedures by Marzouk et al, which were statistically significant. 19 Other studies also support this finding of decreased operative time with use of Del Nido. 20–22 These findings go in line with our study.…”

Section: Discussionmentioning

confidence: 72%

DelNido cardioplegia versus St Thomas cardioplegia solution in double valve replacement: a single centre experience

et al. 2020

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Introduction: The role of cardioplegia cannot be underrated in cardiac surgery. St Thomas solution is the most widely used cardioplegic, but needs repeated dosing. Del Nido solution provides long duration of asystole with adequate protection; but has been used mainly in paediatric patients. This study was aimed to compare Del Nido cardioplegia with St Thomas cardioplegia in adult cardiac surgeries, requiring double valve replacement and compare the outcomes. Methodology: This retrospective, observational, descriptive study was conducted over a time period spanning from January 2016 to December 2019. A total of 209 patients were included and were separated in two groups DC group (n = 114) and BC group (n = 95) on the basis of cardioplegic solution used. Del Nido solution was administered as single dose. Parameters noted were CPB time, cross clamp time, wean off bypass time, DC shocks given, inotropic support required, ventilation duration, duration of ICU and hospital stay. Results: There was significantly shorter aortic cross clamp time (72.6 ± 10.2 vs. 98.2 ± 9.2), CPB time (92.1 ± 12.3 vs.129.5 ± 11) and wean off bypass time (19.4 ± 5.9 vs. 31.3 ± 7.6) and less requirement of DC shocks (21.2% vs. 65.9%) in DC group. Inotropic requirement in immediate post-operative period was significantly less in DC group both on day of surgery (5.35 ± 1.44 vs. 7.52 ± 3.8) and 24 hours later (3.4 ± 2.12 vs. 2.18 ± 0.72). There was no significant difference in duration of ventilation, ICU and hospital stay. Conclusion: Del Nido can be used safely in long duration adult cardiac surgeries and in a single dose with better intra operative and immediate post-operative outcomes as compared to St Thomas solution.

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Transitioning to Del Nido cardioplegia for all-comers: the next switching gear?

Cited by 15 publications

References 25 publications

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

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

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

DelNido cardioplegia versus St Thomas cardioplegia solution in double valve replacement: a single centre experience

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