Whole Blood del Nido versus Cold Blood Microplegia in Adult Cardiac Surgery: A Propensity-Matched Analysis

Abstract

Objectives Few studies have evaluated the outcomes of whole blood microplegia in adult cardiac surgery. Our novel protocol includes removing the crystalloid portion and using the Quest Myocardial Protection System (MPS) for the delivery of del Nido additives in whole blood. This study sought to compare early and late clinical outcomes of whole blood del Nido microplegia (BDN) versus cold blood cardioplegia (CBC) following adult cardiac surgery. Methods A total of 361 patients who underwent cardiac surgery using BDN were compared with a contemporaneous control group of 934 patients receiving CBC. Propensity matching yielded 289 BDN and 289 CBC patients. Chi-square analysis and Fisher's exact test were performed to compare preoperative, operative, and postoperative characteristics on the matched data. Primary outcome was operative mortality, and secondary outcomes included clinical outcomes such as stroke, cardiac arrest, and intra-aortic balloon pump use. The Kaplan–Meier method was used to compare actuarial survival between the two groups using a log-rank test. Results After matching, preoperative characteristics and surgery type were similar between groups. Cardioplegia type did not affect the primary end point of operative mortality. The rate of postoperative intra-aortic balloon pump was lower in BDN patients compared with CBC patients (0 vs. 2%; p = 0.01). There was no difference in late survival. Conclusions Our novel protocol BDN was comparable with CBC, with similar clinical outcomes and no difference in operative mortality or actuarial survival. Further studies should evaluate the long-term outcomes of this technique.

Tepid Modified Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery: A PropensityMatched Analysis

“…They reported that MDNC was safe in high-risk patients undergoing cardiac surgery and in prolonged operations. The same group compared their MDNC strategy with lidocaine containing CBC [ 9 ] . They found comparable clinical outcomes.…”

Effectiveness of Mild to Moderate Hypothermic Cardiopulmonary Bypass on Early Clinical Outcomes

“…Baseline information of the patients, such as demographic data, blood parameters, serum glutamic pyruvic transaminase (SGPT), serum glutamic oxaloacetic transaminase (SGOT), serum bilirubin, blood urea, and left ventricular ejection fraction, were extracted from the medical records. The definitions used for the study are from the Society of Thoracic Surgeons National Cardiac Surgery Database [ 17 ].…”

Efficacy of Whole-Blood Del Nido Cardioplegia Compared with Diluted Del Nido Cardioplegia in Coronary Artery Bypass Grafting: A Retrospective Monocentric Analysis of Pakistan

“…Pre-operative demographic data including, name, gender, age, weight, height, body mass index, history of smoking, and presence of diabetes mellitus were retrieved from the database. The Society of Thoracic Surgeons National Cardiac Surgery Database definitions were used for this study [ 6 ]. Prolonged ventilation was defined as “pulmonary insufficiency requiring a ventilator for >24 h, postoperatively”.…”

“…The ingredients of DNC are mixed with highly oxygenated blood and crystalloid solution with a ratio of 4 times crystalloid to 1 times blood [ 5 ]. However, the Brigham group used it with a ratio of 8:1 (blood to crystalloid) composition [ 6 ]. Due to the ease of administering, single induction dose, and the value of decreasing surgical interruption, its use in adult cardiac surgery gained acceptance [ 4 ].…”