Del Nido Cardioplegia is Safe and Effective Myocardial Protection in Adult Patients Undergoing Cardiac Surgery: A Single Center Experience

Background

Del Nido cardioplegia gains increasing popularity among adult cardiac surgeons. It allegedly allows for up to 90 minutes of safe myocardial ischemia with a single dose.

Aims

The study was performed to evaluate benefits of del Nido cardioplegia.

Methods

Among 2108 patients subjected to coronary or valve surgery with the use of cardiopulmonary bypass (CPB) between Jan 1st 2016 and Sep 30th 2017, 1236 (59%) were protected with del Nido and 872 (41%) with cold-blood cardioplegia. We performed retrospective analysis of prospectively gathered data of all consecutive on-pump patients, to look for early mortality and postoperative troponin T release. Multivariable analysis of both outcomes adjusted for propensity to del Nido cardioplegia was performed.

Results

Patients protected with del Nido cardioplegia had significantly longer CPB and aortic cross-clamp times (p<0.001) but received fewer doses of cardioplegia. Postoperative troponin T levels were significantly higher in del Nido than in cold blood cardioplegia patients (median 0.324 ng/ml [interquartile range 0.210-0.559] vs. 0.285 ng/ml [0.191-0.496]; p=0.01). However, when adjusted to cross clamp time, propensity to del Nido cardioplegia and other factors, del Nido cardioplegia lowered postoperative troponin T. The early mortality did not differ between the groups (3.6% vs 3.0% [p=0.54]).

Conclusions

Del Nido cardioplegia is a safe and effective method of myocardial protection in adult cardiac surgery. It allows for longer redosing interval with safety profile and mortality
comparable to cold blood cardioplegia as exemplified by lower troponin T release when corrected for the time of myocardial ischemia.