Del Nido cardioplegia in adult cardiac surgery: Clinical outcomes in a single center all-comer study

Lorenzo Di Bacco; Fabrizio Rosati; Alberto Repossini; Massimo Baudo; Mauro Renghini; Debora Maddinelli; Francesca Boldini; Francesca Zanin; Cesare Tomasi; Claudio Muneretto; Stefano Benussi

doi:10.1177/02676591231211492

Del Nido cardioplegia in adult cardiac surgery: Clinical outcomes in a single center all-comer study

Perfusion. 2023 Nov 9:2676591231211492. doi: 10.1177/02676591231211492. Online ahead of print.

Affiliations

¹ Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy.
² Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

PMID: 37944914
DOI: 10.1177/02676591231211492

Abstract

Introduction: The use of Del Nido Cardioplegia (DNC) has been extended in the latest years from pediatrics to adult cardiac surgery with encouraging results. We sought to investigate clinical and biochemical outcomes in adult patients who underwent cardiac surgery with different degrees of complexity who received DNC for myocardial protection.

Methods: Data on one-thousand patients were retrospectively collected from 2020 to 2022. The only exclusion criteria was off-pump adult cardiac surgery. Surgical procedures weight was categorized according EuroSCORE II in six groups: Single-CABG(G1), isolated non-CABG(mitral) (G2), isolated non-CABG(aortic) (G3), isolated non-CABG(any) (G4), 2-procedures(G5), 3/more-procedures(G6). Primary endpoint was to identify a binomial correlation between hs-TnT/CK-MB and the cross-clamp time (X-Clamp). A secondary endpoint was the comparison between the treatment groups of the vasoactive-inotropic score (VIS) and the need of mechanical circulatory support (MCS).

Results: A linear correlation was identified between hs-TnT and X-clamp in the overall population (rho:0.447, p< .001) and in the treatment groups (G1:rho=0.357, p< .001/G2:rho=0.455, p< .001/G3:rho=0.307, p= .001/G4:rho=0.165, p= .257/G5:rho=0.157, p= .031/G6:rho=0.226, p= .015). Similarly, a linear correlation between CK-MB and X-clamp in the overall population (rho=0.457, p< .001) and treatment group (G1:rho=0.282, p< .001/G2:rho=0.287, p= .025/G3:rho=0.211, p= .009/G4:rho=0.0878, p= .548/G5:rho=0.309, p< .001/G6: rho=0.212, p= .024) was identified. As regard for the secondary endpoint, no differences were reported between the treatment groups in terms of VIS and MCS (VIS G1:7; G2:4; G3:7; G4:7, G5:5.5, G6:6, p-value= .691) (MCS G1: 4.5%; G2:4.8%; G3:3.3%; G4:3.1%; G5:1.4%; G6:5.3%; p-value= .372).

Conclusions: Del Nido Cardioplegia is a safe and useful tool in adult cardiac surgery allowing operators to achieve a stable and durable cardioplegic arrest. Despite accounting with different types of surgery, the six subgroups of our study population showed similar perioperative results.

Keywords: del nido cardioplegia; myocardial protection; postoperative mechanical circulatory support; vasoactive inotropic score.