Del Nido cardioplegia in adult cardiac surgery: beyond single-valve surgery. (14th February 2018)

• Record Type: Journal Article
• Authors: Kim, Wan Kee; Kim, Hong Rae; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 27:Number 1(2018)
• Page Start: 81
• Page End: 87
• Publication Date: 2018-02-14
• Subjects: Myocardial ischaemia -- Cardiac function -- Cardiopulmonary bypass -- Heart valve prosthesis; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivy028
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: In recent years, the use of del Nido (DN) cardioplegia has been reported in single-valve surgery or isolated coronary artery bypass surgery with acceptable outcomes. The reports of its use in more complex adult cardiac procedures, however, have been scarce. METHODS: We enrolled a total of 149 adult patients who underwent heart valve surgery with the use of DN cardioplegia between May 2014 and December 2016. For a benchmark comparison, 892 patients who underwent cardiac valve surgery with blood cardioplegia during the same period served as controls. To reduce selection bias, propensity score matching was used; the inverse probability of treatment weighting method was performed for further validations. RESULTS: Overall, 57.7% of patients in the DN group underwent multiple or complex cardiac procedures. Early mortality rates were 0.7% and 2.4% in the DN and blood groups, respectively ( P = 0.31). Propensity score matching yielded 111 pairs of patients who were well balanced for all 23 measured baseline covariates. In the matched cohort, the postoperative peak troponin I levels ( P = 0.004) and the aortic clamping times ( P < 0.001) were significantly lower and shorter compared with those in the blood group. There were no significant differences in early mortality rates (1.9% vs 0%, P > 0.99), low cardiac output ( P = 0.57) and neurological events ( P = 0.21). The quantities of postoperative transfusions ( P = 0.008) and fluid supplements ( P < 0.001) were significantly lower in the matched DN group compared with the blood group. CONCLUSIONS: The use of DN in adult valve surgery including complex procedures may confer acceptable outcomes comparable to or even superior to those obtained with the use of blood cardioplegia.