Use of Del Nido and Blood Cardioplegia in Adult Cardiac Surgery
Ji Seong Kim, Ho Young Hwang, Jin Hee Jeong, Sin Ju Moon, Hyuk Ahn.
Seoul National University Hospital, Seoul, Korea, Republic of.
OBJECTIVE: We compared early results including myocardial troponin level and clinical outcomes after adult cardiovascular surgery using del Nido and blood cardioplegia.
METHODS: 140 patients(59±14years) who underwent cardiovascular surgery using del Nido(DN group, n=38) or blood(BC group, n=102) cardioplegia were enrolled. Propensity score analyses were performed and the levels of troponin I(TnI) and early clinical outcomes in the 2 groups were compared.
RESULTS: In the DN group, cardioplegia was infused with an initial dose of 1127±224mL, and an additional 500mL was reinfused in 12 patients 92.2min after initial infusion. In the BC group, the number of infusions and infused volumes were 4.0±1.6 and 2746±1220mL, respectively. After release of aortic cross clamp(ACC), spontaneous defibrillation was achieved more frequently in the DN than BC groups(34/38 vs 26/102, p<0.001). The peak TnI levels after surgery were 10.2(2.0-90.2) and 17.8(3.5-153.9)ng/mL in the DN and BC groups, respectively. There were no differences in the peak level and serial changes of TnI between the 2 groups(p=0.802). In the DN group, ACC time was not associated with the peak TnI level. In the BC group, however, ACC time was a significant factor associated with peak TnI after surgery(p<0.001). There were no significant differences in early mortality(n=3) and postoperative complication rates between the 2 groups. Propensity score matching extracted 30 pairs. The levels of TnI and clinical outcomes were similar between the 2 propensity score-matched groups.
CONCLUSIONS: Del Nido cardioplegia is as effective as blood cardioplegia for adult patients in terms of myocardial protection and early clinical outcomes, and its single-dose and small-volume properties might be beneficial in minimally invasive adult cardiac surgeries.
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