Myocardial Protection Of Del Nido Versus St.Thomas Cardioplegia In Adult Patients Undergoing Minimal Invasive Valve Replacement Surgery.
VIJAYANT DEVENRAJ, AJAY KUMAR PANDEY, SUSHIL KUMAR SINGH, SARVESH KUMAR, NAVNEET DEVENRAJ.
KING GEORGE'S MEDICAL UNIVERSITY, LUCKNOW, India.
BACKGROUND: St.Thomas cold blood cardioplegia (ST) is most commonly used cardioplegia which requires repeated administration at interval of 18 to 23 minutes and is hyperkalemic solution . This compared to del Nido cardioplegia (DN), which is administered at 60 -90 minutes leading to less frequent dosing & volume, is less hyperkalemic and has different chemical composition. In our study we aim to compare effect of del Nido cardioplegia solution with St.Thomas cold blood cardioplegia for myocardial protection in adult patients undergoing minimal invasive valve replacement surgery. METHODS: A Single centre, prospective, randomised, case control study was done in department of CTVS , KGMU, Lucknow. 60 patients were divided in 2 groups , group 1 recieved del Nido cardioplegia and group 2 St.Thomas cardioplegia . We analysed the total cardiopulmonary bypass time(CPB), aortic cross clamp time(ACC), volume and number of cardioplegia used, , time to wean off CPB , intra-op defibrillation requirement & post-operative myocardial biochemical markers CPKMB, Trop T, NT-Pro BNP . RESULTS: Del Nido group was associated with significantly (p<0.05) shorter CPB time(121.34+-17.86 v/s 159.3+-24.37) and ACC time (84.2+-20.8 v/s 122.8+-24.76) . Lesser cardioplegia volume and fewer number was required with del Nido group ( 1368.4 +-70 v/s 2765.6+-56.3 ml and 1.4+-0.6 v/s 3.9+-1.5 ) respectively. Defibrillation requirement was less in del Nido group (0.4 v/s 1.9) and time to wean off CPB was comparable(24.45+-4.32 v/s 25.26+-3.34 min) . Post operative rise in NT-Pro Bnp and was sigmificantly more in St.Thomas cardioplegia group. CONCLUSION: Del Nido cardioplegia provides with equal or better myocardial protection than St.Thomas cold blood cardioplegia solution in patients undergoing minimal invasive valve replacement surgery under CPB.
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