Use of del Nido cardioplegia in adult cardiac surgery

Abstract

In most adult cardiac surgery operations, the heart must be completely immobile and isolated from the blood. Therefore, the heart is stopped in diastole and a still operative site is obtained. Cardiac arrest results in ischemiareperfusion injury. For these reasons, myocardial protection and the prevention of damages are required. Various cardioplegia solutions are used for this purpose. It can be said that cardioplegia is the gold standard method of myocardial protection in cardiac arrest. Nowadays, "Single-dose cardioplegia" applications are increasingly used, especially in minimally invasive cardiac surgery and basic coronary bypass procedures due to the advantages they provide, which include reduction of aortic cross-clamp time, prevention of frequent interruption of the procedure due to cardioplegia, and reduced postoperative myocardial dysfunction incidence. The two main solutions used in single dose cardioplegia applications are the Bretschneider solution and the del Nido extracellular cardioplegia solution. The del Nido cardioplegia solution (dNCS), which was originally developed for use in pediatric cardiac surgery, has recently increased its use in adult cardiac surgery due to straightforward application and long-term effectiveness. The del Nido cardioplegia reduces the aortic cross clamp duration, cardiopulmonary bypass time and required cardioplegia solution volume, and is a safer and superior cardioplegia solution and technique in terms of myocardial protection with regards to many organs and cardiacbiochemical parameters.

Comparison of routine del Nido cardioplegia vs two types of modified del Nido cardioplegias for myocardial protection among patients undergoing coronary artery bypass grafting (CABG) surgeries: A randomized double-blind clinical trial

“…The solution's efficacy and safety make it a promising option for cardiac surgery in both adult and pediatric populations (7,8). Del Nido cardioplegia has also been proven effective in adult minimal invasive cardiac surgeries and acquired cases (coronary artery bypass, valvular, and combined surgeries) (9)(10)(11).…”

“…CPB time and total operation time were significantly shorter in the del Nido group. Additionally, Amac et al(9) conducted a review of articles regarding the use of single-dose Bretschneider cardioplegia and single-dose del Nido cardioplegia in adult cardiac surgery. Their findings showed that del Nido cardioplegia was a superior and safer technique for myocardial protection, resulting in reduced aortic cross-clamp duration, cardiopulmonary bypass time, and required cardioplegia solution volume.…”

Comparison of Clinical Outcomes between del Nido Cardioplegia and Microplegia among Patients Undergoing Elective Mitral Valve Replacement

“…For efficient cardioplegias, it is important to provide rapid diastolic arrest to reduce the consumption of adenosine triphosphate and phosphocreatine by myocytes, and to prevent reperfusion injury [3]. Cardioplegia solutions can be classified as crystalloids or blood cardioplegias according to their composition, and either cold or hot according to the temperature at which they are infused.…”

Use of Different Cardioplegia Solutions in Heart Valve Surgery

“…Its effectiveness has been demonstrated in many studies in adult cardiac surgery [ 2 , 3 ] . However, the lack of a standard preparation, the high potassium content, and the risks of lidocaine toxicity in repeated doses are its disadvantages [ 4 ] . Custodiol® is used in complex cardiac surgery and transplant surgery in many centers with a single dose.…”