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Use of Del Nido Cardioplegia in MICS Cases - 4 Years of Surgical Experience and Follow Up
Ashwani Bansal, Milind P Hote, V Devagourou, Balram Airan.
AIIMS, New Delhi, India.

OBJECTIVE: Minimal invasive cardiac surgery (MICS) requires adequate visualization of operative field through small incisions and the expected clamp times are higher. To avoid repeated manipulations, it is desirable to use single dose cardioplegia with good myocardial protection. Aim of the present study was to determine whether del Nido cardioplegia could be used safely and effectively in MICS.
METHODS: Minimal invasive cardiac surgery (MICS) requires adequate visualization of operative field through small incisions and the expected clamp times are higher. To avoid repeated manipulations, it is desirable to use single dose cardioplegia with good myocardial protection. Aim of the present study was to determine whether del Nido cardioplegia could be used safely and effectively in MICS.
RESULTS: MICS was done for 41 ASD (73%), 10 MR (17.8%), 2 MS (3.5%), 1 AR, 1 AVSD and 1 SV ASD patients. Mean age was 19.4 yrs (4 to 39 yrs) and the mean weight of patients was 42.9 kg. Mini thoracotomy approach (5 cm incision) was used in 26 patients (46.4%), mini sternotomy in 7 (12.5%) while right thoracotomy was performed in rest 23 (41%) patients. Surgical procedure could be completed with a single dose of del Nido cardioplegia in 90 % cases (50 out of 56) with a mean cross clamp time of 44.2 minutes. No patient required retrograde cardioplegia and stable rhythm was achieved in 53 / 56 patients. In ICU 3 (5.3%) patients required temporary pacing; all reverting to sinus rhythm after mean interval of 12.6 hrs. Post operative recovery was smooth with mean inotropic score (IS) being 1.6 ( at 1 hr ) and 0.26 ( at 24 hrs ) respectively. Early extubation was achieved for all patients, with mean ventilation time of 6.6 hrs, leading to short ICU (mean 1.2 days) and hospital stays (mean 5.4 days). With a mean follow up duration of 29.3 months, all patients are asymptomatic with normal LV function.
CONCLUSIONS: del Nido cardioplegia is safe and convenient alternative for MICS.


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