One Shot Del Nido Cardioplegia in Minimally Invasive Aortic Valve Surgery: Comparison with Multidose Buckberg Cardioplegia
Giuseppina G. Surace, Tiziano Torre, Michele Gallo, Francesca Toto, Thomas Theologou, Massimo Le Pera, Daniele Eccel, Gianluca Agus, Giorgio Franciosi, Enrico Ferrari, Stefanos Demertzis
Cardiocentro Ticino, Lugano, Switzerland
BACKGROUND: Del Nido cardioplegia (DC) is widely used for myocardial protection during adult cardiac surgery with good safety and results. The advantage of single-dose cardioplegia is appreciated especially in minimally invasive surgery because the working interruptions for multiple dose administration are not required. We retrospectively assessed its potential impact to operative times, postoperative myocardial injury and outcomes. METHODS: From August 2003 to June 2015 the prevalent approach was right minithoracotomy and Buckberg cardioplegia (BC). From July 2015 to December 2019 the prevalent approach was upper ministernotomy and DC. We matched the patients for gender and diabetes. A total of 110 isolated minimally-invasive aortic valve replacement (55 patients for each group) were analyzed. Intraoperative and postoperative data were retrospectively reviewed and compared using t-test and chi-squared test. RESULTS: The two groups were comparable, with no difference in age, gender, comorbidity and cardiac status. No death in neither group. Mean operation time and cardiopulmonary bypass (CPB) time were statistically longer in BC group (p<0.001) with higher lactate levels (p=0.001). In the DC group there was a statistically significant less need for defibrillation after cross-clamp release (p<0.001). Patients in BC group received more blood transfusions during CPB (P<0.001), more intraoperative insuline administration for higher glucose levels (P<0.001). The maximum postoperative Creatine Kinase-MB (CK-MB), incidence of postoperative atrial fibrillation and hospital length of stay were similar. (Table 1)
CONCLUSIONS: One-shot Del Nido cardioplegia allows for a smooth and more comfortable minimally invasive surgery. Compared to BC, DC provides better myocardial protection through significantly more spontaneous return of regular heartbeat. It allows for less CPB time and consequent less stress conditions attested by lower intraoperative lactate levels, lower peak of glucose, less need of insuline administration and blood transfusions (p<0.005).
LEGEND:CK-MB: Creatine Kinase-MB; CPB: cardiopulmonary bypass; LOS: length of stay; SD: standard deviation.
| Buckberg group (n=55) | Del Nido group (n=55) | p value | |
| CPB time (mean min ± SD) | 120.8 ± 35.3 | 90.8 ± 31.8 | <0.001 |
| Cross-Clamp time (mean min ± SD) | 73.2 ± 17.1 | 69.3 ± 22.4 | 0.3 |
| Internal defibrillation No. (%) | 36 (65.4%) | 8 (14.5%) | <0.001 |
| Transfusions No. (%) | 21 (38.1%) | 5 (9.1%) | 0.001 |
| Peak lactate (mmol/L mean ± SD) | 2.0 ± 1.1 | 1.5 ± 0.6 | 0.001 |
| Peak Glucose (mmol/L mean ± SD) | 12.0 ± 2.3 | 8.1 ± 1.7 | <0.001 |
| CK-MB (U/l mean ± SD) | 66.2 ± 100.5 | 49.9 ± 99.5 | 0.4 |
| Atrial fibrillation No. (%) | 20 (36.3%) | 25 (45.4%) | 0.4 |
| LOS (days mean ± SD) | 8.5 ± 3.4 | 8.6 ± 2.9 | 0.8 |