Myocardial Protection Using Del Nido Cardioplegia Solution in Adult Reoperative Aortic Valve Surgery

BACKGROUND AND AIMS:

The immediate postischemic period is
marked by elevated intracellular calcium levels, which can lead to
irreversible myocyte injury. Del Nido cardioplegia was developed for use
in the pediatric population to address the inability of immature
myocardium to tolerate high levels of intracellular calcium following cardiac surgery. Our aim in this study is to determine if this solution can be used safely and effectively in an adult, reoperative population.

METHODS:

All
patients undergoing isolated reoperative aortic valve replacement at
our institution from 2010 to 2012 were retrospectively reviewed.
Demographics, comorbidities, operative variables, postoperative
complications, and patient outcomes were collected. Patients were
divided into two groups based on cardioplegia strategy used: whole blood
cardioplegia (WB, n = 61) and del Nido cardioplegia (DN, n = 52).

RESULTS:

Mean
age in the study was 73.4 ± 14.3 years and 86 patients were male
(76.1%). Eighty-four patients had undergone prior coronary artery bypass
graft (CABG) (74.3%). Patients in the DN group required significantly
lower total volume of cardioplegia (1147.6 ± 447.2 mL DN vs.
1985.4 ± 691.1 mL WB, p < 0.001) and retrograde cardioplegia dose (279.3 ± 445.1 mL DN vs. 1341.2 ± 690.8 mL WB, p < 0.001). There were no differences in cross-clamp time, bypass time, postoperative complication rate, or patient outcomes between groups.

CONCLUSIONS:

Del
Nido cardioplegia use in an adult, reoperative aortic valve population
offers equivalent postoperative outcomes when compared with whole blood
cardioplegia. In addition, use of del Nido solution requires lower total
and retrograde cardioplegia volumes in order to achieve adequate
myocardial protection.