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Abstract

Introduction

Del Nido cardioplegia (DN) is gaining acceptance in adult cardiac surgery but there is paucity of experimental data regarding its efficacy. We set out to assess the safety and efficacy of single-dose DN with and without topical cooling (TC) versus multi-dose blood cardioplegia (BC).

Methods

Thirty-two healthy adult sheep had pressure-volume (PV) catheters placed in the left (LV) and right (RV) ventricle. Animals were assigned to receive cold (4°C) antegrade solution for a 60-min arrest using: (1) multi-dose (every 20 min) BC with TC (n = 11), (2) single-dose DN with TC (DN-C, n = 10), or (3) single-dose DN without TC (DN-H, n = 11). LV and RV PV-derived indexes, epicardial echocardiographic strains, and blood samples were acquired before CPB and at 1, 2, and 3 h of reperfusion. Dobutamine bolus (2.5 μg) was given after 3 h to test for myocardial reserve.

Results

Time to rhythm restoration was shortest (54 ± 29 s, 118 ± 167 s, and 172 ± 170 s for DN-H, DN-C, and BC, respectively; p = 0.024) and number of shocks lowest (1.7 ± 1.8, 3.6 ± 2.8, and 5.6 ± 4.6 for DN-H, DN-C, and BC, respectively; p = 0.020) in DN-H group. Hemodynamic, load-independent myocardial function, echocardiographic, and metabolic data revealed only slight differences between groups. Troponin I levels did not differ between groups. With dobutamine, preload-recruitable stroke work of both LV (136 ± 50%, 131 ± 31%, 142 ± 58% for BC, DN-C and DN-H, respectively; p = 0.993) and RV (161 ± 67%, 185 ± 45%, 166 ± 75% for BC, DN-C and DN-H respectively; p = 0.580) increased similarly.

Conclusions

Single-dose DN cardioplegia with or without topical cooling offered comparable biventricular myocardial protection to multi-dose BC for a 60-min arrest in sheep.

Keywords

del Nido cardioplegia right ventricle myocardial protection blood cardioplegia

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References

Sá

MPBO

Rueda

Ferraz

, et al. Is there any difference between blood and crystalloid cardioplegia for myocardial protection during cardiac surgery? a meta-analysis of 5576 patients from 36 randomized trials. Perfusion 2012; 27(6): 535–546.

Matte

del Nido

. History and use of del Nido Cardioplegia solution at Boston children’s hospital. J Extra Corpor Technol 2012; 44(7): 98–103.

Yammine

Neely

Loberman

, et al. The use of lidocaine containing cardioplegia in surgery for adult acquired heart disease. J Card Surg 2015; 30(9): 677–684.

Mick

Robich

Houghtaling

, et al. Del Nido versus Buckberg cardioplegia in adult isolated valve surgery. J Thorac Cardiovasc Surg 2015; 149(2): 626–634.

Timek

Willekes

Hulme

, et al. Propensity matched analysis of del Nido Cardioplegia in adult coronary artery bypass grafting: initial experience with 100 consecutive patients. Ann Thorac Surg 2016; 101(6): 2237–2241.

Gambardella

Gaudino

MFL

Antoniou

, et al. Single-versus multidose cardioplegia in adult cardiac surgery patients: a meta-analysis. J Thorac Cardiovasc Surg 2020; 160(5): 1195–1202.e12.

Kuciński

Górska

Deja

. Del Nido cardioplegia as a safe and effective method of myocardial protection in adult patients undergoing cardiac surgery: a single-center experience. Kardiol Pol 2019; 77(11): 1040–1046.

Lenoir

Bouhout

Jelassi

, et al. Del Nido cardioplegia versus blood cardioplegia in adult aortic root surgery. J Thorac Cardiovasc Surg 2021; 162(2): 514–522.e2.

Holmes

Massimiano

, et al. The use of del Nido cardioplegia in adult cardiac surgery: a prospective randomized trial. J Thorac Cardiovasc Surg 2018; 155(3): 1011–1018.

10.

Sanetra

Gerber

Shrestha

, et al. The del Nido versus cold blood cardioplegia in aortic valve replacement: a randomized trial. J Thorac Cardiovasc Surg 2020; 159(6): 2275.e1–2283.e1.

11.

Nakao

Morita

Shinohara

, et al. Excellent restoration of left ventricular compliance after prolonged Del Nido Single-Dose cardioplegia in an in vivo piglet model. Semin Thorac Cardiovasc Surg 2020; 32(3): 475–483.

12.

Govindapillai

Hua

Rose

, et al. Protecting the aged heart during cardiac surgery: use of del nido cardioplegia provides superior functional recovery in isolated hearts. J Thorac Cardiovasc Surg 2013; 146(4): 940–948.

13.

Estrada

VHN

Franco

DLM

Moreno

AAV

, et al. Postoperative right ventricular failure in cardiac surgery. Cardiol Res 2016; 7(6): 185–195.

14.

Christakis

Fremes

Weisel

, et al. Right ventricular dysfunction following cold potassium cardioplegia. J Thorac Cardiovasc Surg 1985; 90(2): 243–250.

15.

Gertz

Wisneski

Neese

, et al. Myocardial lactate extraction: multi-determined metabolic function. Circulation 1980; 61(2): 256–261.

16.

Ucak

Uncu

. Comparison of del nido and intermittent warm blood cardioplegia in coronary artery bypass grafting surgery. Ann Thorac Cardiovasc Surg 2019; 25(1): 39–45.

17.

Ziazadeh

Mater

Himelhoch

, et al. Single-dose del Nido Cardioplegia in minimally invasive aortic valve surgery. Semin Thorac Cardiovasc Surg 2017; 29(4): 471–476.

18.

Natarajan

Nakhjavan

Kahn

, et al. Myocardial metabolic studies in prolapsing mitral leaflet syndrome. Circulation 1975; 52(6): 1105–1110.

19.

Székely

Levin

Miao

, et al. Impact of hyperglycemia on perioperative mortality after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2011; 142(2): 430–437.e1.

20.

Breisblatt

Stein

Wolfe

, et al. Acute myocardial dysfunction and recovery: a common occurrence after coronary bypass surgery. J Am Coll Cardiol 1990; 15(6): 1261–1269.

21.

Scherptong

RWC

Mollema

Blom

, et al. Right ventricular peak systolic longitudinal strain is a sensitive marker for right ventricular deterioration in adult patients with tetralogy of fallot. Int J Cardiovasc Imaging 2009; 25(7): 669–676.

22.

Donauer

Schneider

Jander

, et al. Perioperative changes of right ventricular function in cardiac surgical patients assessed by myocardial deformation analysis and 3-dimensional echocardiography. J Cardiothorac Vasc Anesth 2020; 34(3): 708–718.

23.

Schwartz

Greyson

, et al. Low-dose inotropic stimulation during left ventricular ischaemia does not worsen post-ischaemic dysfunction. Cardiovasc Res 1996; 32(6): 1024–1037.

24.

Guajardo Salinas

Nutt

Rodriguez-Araujo

. Del Nido cardioplegia in low risk adults undergoing first time coronary artery bypass surgery. Perfusion 2017; 32(1): 68–73.

25.

O’Blenes

Friesen

Ali

, et al. Protecting the aged heart during cardiac surgery: The potential benefits of del Nido cardioplegia. J Thorac Cardiovasc Surg 2011; 141(3): 762–770.

26.

Corno

Zoia

Santoro

, et al. Epicardial damage induced by topical cooling during paediatric cardiac surgery. Br Heart J 1992; 67(2): 174–176.

27.

Kadan

Erol

, et al. Effects of topical hypothermia on postoperative inflammatory markers in patients undergoing coronary artery bypass surgery. Cardiovasc J Afr 2014; 25(2): 67–72.

28.

Lichtenstein

Ashe

el Dalati

, et al. Warm heart surgery. J Thorac Cardiovasc Surg 1991; 101(2): 269–274.

29.

Alassar

Bazerbashi

Moawad

, et al.

What is the value of topical cooling as an adjunct to myocardial protection?

Interact Cardiovasc Thorac Surg 2014; 19(5): 856–860.

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Myocardial protection using single dose del Nido Cardioplegia with and without topical cooling