Del Nido cardioplegia versus blood cardioplegia in coronary artery bypass grafting.

Pub Date : 2024-01-01 Epub Date: 2023-08-30 DOI:10.1007/s12055-023-01584-7
Lokeswara Rao Sajja, Gopichand Mannam, Devanish Narasimhasanth Kamtam, SatyaBhaskara Raju Dandu, Satyendranath Pathuri, Krishnamurthy Venkata Satya Siva Saikiran, Balakrishna Nagalla, Sriramulu Sompalli, Satyanarayana Ghanta
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Abstract

Purpose: The del Nido cardioplegia (DC) has been extensively used in congenital heart surgery for over two decades and is becoming popular in adult cardiac surgery. We evaluated the efficacy and safety of DC, compared to conventional blood cardioplegia (BC), in adult patients undergoing isolated coronary artery bypass grafting (CABG).

Methods: This metachronous study included a total of 2330 consecutive patients who underwent isolated CABG. The study population was divided into two groups: BC group, consisting of 1165 patients (May 2012 through December 2015); and DC (del Nido) cardioplegia group consisting of 1165 patients (January 2016 through June 2018). Propensity matching yielded 735 well-matched pairs. The propensity-matched cohorts of BC and DC were compared in terms of myocardial function outcomes and other clinical outcomes to determine the efficacy and safety of both the cardioplegic solutions.

Results: There was no difference in 30-day mortality [odds ratio (OR), 0.74; 95% confidence interval (CI), 0.16-3.35, p = 0.70]. There was a significant decrease in the DC group in the postoperative events, including re-exploration rates [OR, 0.25; 95% CI, 0.118-0.568, p < 0.001], myocardial infarction [OR, 0.282; 95% CI, 0.133-0.596, p < 0.001], left ventricular dysfunction [OR, 0.60; 95% CI, 0.396-0.916, p = 0.018], and acute kidney injury (AKI) [OR, 0.255; 95% CI, 0.156-0.418, p < 0.001]. The rate of spontaneous return to sinus rhythm was significantly higher in the DC group [OR, 5.162; 95% CI, 3.701-7.198, p < 0.001]. Cardiopulmonary bypass time (95.2 ± 29.1 min vs. 82.1 ± 28.8 min, p < 0.001) and aortic cross-clamp (ACC) time (57.3 ± 19 min vs. 48.7 ± 19.0 min, p < 0.001) were higher in the DC group, but the absolute difference in ACC time was only 8 min. There was no difference in AKI requiring renal replacement therapy [OR, 0.62; 95% CI, 0.203-1.912, p = 0.40], postoperative cerebrovascular accidents [OR, 0.398; 95% CI, 0.077-2.059, p = 0.073], and postoperative ventricular arrhythmias [OR, 0.80; 95% CI, 0.456-1.916, p = 0.47].

Conclusion: This study revealed comparable clinical outcomes and effective myocardial protection with DC, compared to BC in patients undergoing isolated CABG. In addition, DC demonstrated the ease of administration with the feasibility of single-dose administration.

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Del Nido心脏停搏液与血液停搏液在冠状动脉搭桥术中的比较
目的:二十多年来,德尔尼多心脏麻痹(DC)已广泛应用于先天性心脏病手术,并逐渐在成人心脏手术中流行起来。我们评估了在接受孤立冠状动脉旁路移植术(CABG)的成人患者中,DC 与传统血液心脏麻痹(BC)相比的有效性和安全性:这项同步研究共纳入了 2330 名连续接受孤立的冠状动脉旁路移植术的患者。研究对象分为两组:BC组,由1165名患者组成(2012年5月至2015年12月);DC(del Nido)心脏麻痹组,由1165名患者组成(2016年1月至2018年6月)。倾向匹配产生了 735 对匹配良好的患者。对倾向匹配的BC组和DC组的心肌功能结果和其他临床结果进行了比较,以确定两种心脏麻痹溶液的有效性和安全性:30天死亡率无差异[比值比 (OR),0.74;95% 置信区间 (CI),0.16-3.35,P = 0.70]。直流电组的术后事件明显减少,包括再次探查率[OR,0.25;95% CI,0.118-0.568,P P = 0.018]和急性肾损伤(AKI)[OR,0.255;95% CI,0.156-0.418,P P = 0.018]。418,P P P = 0.40]、术后脑血管意外[OR,0.398;95% CI,0.077-2.059,P = 0.073]和术后室性心律失常[OR,0.80;95% CI,0.456-1.916,P = 0.47]:本研究显示,与 BC 相比,在接受孤立的 CABG 患者中使用 DC 可获得相似的临床结果和有效的心肌保护。此外,DC 显示了单剂量给药的可行性和给药的简便性。
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