International Society For Minimally Invasive Cardiothoracic Surgery

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Del Nido Cardioplegia Provides Safe And Effective Protection For Closed Chest Operations
Neel K. Ranganath, Jad Malas, Katherine G. Phillips, Neil Edson, Deane E. Smith, Didier F. Loulmet, Aubrey C. Galloway, Eugene A. Grossi.
NYU Langone Health, New York, NY, USA.

Background: Advantages of del Nido cardioplegia(DNC) over Buckberg cardioplegia(BC) include longer re-dosing intervals and lower cardioplegia volume delivered. While totally endoscopic robotic cases may derive benefit from having fewer interruptions for cardioplegia administration, adequacy of myocardial protection remains unknown. We reviewed case-matched outcomes of DNC vs BC in intra-cardiac robotic patients. Methods: From 5/11 to 4/18, 601 consecutive patients underwent robotic intra-cardiac surgery requiring cardioplegia at a single institution using the daVinciXi Surgical System(Intuitive Surgical, Sunnyvale, CA). Operations were performed via right chest ports without mini-thoracotomy. After an initial experience with BC (n=73), we transitioned to DNC in 5/13. We case-matched DNC and BC groups based on age, gender, cross-clamp time, and left ventricular ejection fraction resulting in 66 patients in each group. Parametric and non-parametric tests were used to analyze differences between the case-matched groups. Statistical analysis was performed using SPSS 25(IBM Corp, Armonk, NY). Results: Mitral repairs accounted for 95%(125/132) of our case-matched operations. Median bypass and cross-clamp time in DNC patients were 115 minutes and 80 minutes, respectively. DNC was associated with less frequent re-dosing(median number of injections 2 vs 4, p<0.001), greater rates of single-injection cardioplegia administration(22.7% vs 7.6%, p=0.027), and less cardioplegia volume delivered(median 2000 vs 3100 mL, p<0.001)(Table). DNC and BC had similar rates of antegrade/retrograde(66.7% vs 69.7%), antegrade only(30.3% vs 28.8%), and retrograde only(3.0% vs 1.5%) cardioplegia delivery(p=0.817). DNC and BC groups had similar salvaged blood utilization(340 vs 300 mL, p=0.080), similar post-operative glucose levels(163 vs 149, p=0.069), and similar intra-operative blood product utilization(10.6% vs 9.1%, p=1.000). Both DNC and BC patients had similar rates of prolonged post-operative inotropic(13.6% vs 13.6%, p=1.000) or vasopressor(16.7% vs 11.4%, p=0.583) support. There were no 30-day mortalities in either group. Median hospital length of stay(LOS) was four days in both DNC and BC patients(p=0.627). Conclusions: By minimizing the frequency of re-dosing, DNC allows fewer interruptions for cardioplegia administration than BC. Utilization of DNC did not compromise patient outcomes compared to BC as evidenced by similar rates of prolonged inotropic and vasopressor support, equivalent hospital LOS, and no 30-day mortalities.

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