Biju Kambil Thyagarajan1, Anandakuttan Sreenivasan2
BACKGROUND
The del Nido cardioplegia was devised and introduced as a single dose cardioplegia
for myocardial protection in congenital heart surgery by Petro del Nido and team.
The most commonly used cardioplegia in adult cardiac surgery was multidose
blood cardioplegia which has to be repeated every 25 to 30 minutes to maintain
cardiac arrest. For this, the surgery has to be interrupted leading to prolonged
cardiopulmonary bypass and aortic cross clamp time. With promising results of del
Nido cardioplegia in adult cardiac surgery, more and more centres adopted this
single dose cardioplegia in adult cardiac surgery. We retrospectively analysed the
safety and efficacy of del Nido cardioplegia and compared them with those of
conventional blood cardioplegia in isolated coronary artery bypass surgery.
METHODS
We have been using multidose conventional blood cardioplegia (CBCP) solution for
all our cardiac surgeries. We changed the cardioplegia protocol to single dose del
Nido cardioplegia (DNCP) solution in October 2016. We collected the preoperative,
intraoperative and post-operative data of 100 patients in each group, who
underwent elective isolated coronary artery bypass surgery.
RESULTS
The baseline demographic features, pre- and post-operative cardiac function,
number of coronary arteries involved, and comorbidities were similar in both
groups. There was a statistically significant reduction in cardiopulmonary bypass
time (77.16 ± 13.13 minutes vs. 121.69 ± 28.18 minutes, P-value < .00001) and
aortic cross clamp time (57.71 ± 10.6 minutes vs. 77.26 ± 20.29 minutes, p value
< .00001) in the DNCP group. The total dose of cardioplegia solution required was
significantly less in DNCP group (1000 mL vs. 2393.56 ± 592.42 mL, P-value
< .00001). The mean post-operative hospital stay in DNCP group was 7.87 ± 1.25
days as compared to 12.49 ± 1.29 days in CBCP group with a P-value < .00001.
CONCLUSIONS
The del Nido cardioplegia solution is associated with shorter cardiopulmonary
bypass and aortic cross clamp time, less volume of cardioplegia solution and
shorter mean hospital stay. The del Nido cardioplegia can be used in adult cardiac
surgery with the same safety of conventional blood cardioplegia in adult isolated
coronary artery bypass surgery.
