OBJECTIVE:
Del Nido cardioplegia (DC) offers prolonged cardiac protection with single dose administration and has been shown to be safe in adult CABG surgery. We set out to evaluate the efficacy of cardiac protection and clinical outcomes of del Nido cardioplegiaversus standard blood cardioplegia (BC) in minimally invasive aortic valve surgery.
METHODS:
From 8/2011 to 5/2016, 178 patients underwent minimally invasive aortic valve replacement (AVR) with BC (n=101) or DC (n= 77). Mini-sternotomy or right mini-thoracotomy was utilized for surgical access. Clinical patient characteristics and data were extracted from our local Society of Thoracic Surgeons (STS) database and the electronic medical record. Patients were propensity matched for age, gender, BMI, valve size and type, STS score, surgical access, pre-op creatinine, diabetes, and COPD yielding 63 well matched pairs.
RESULTS:
There was no difference in patient age, pre-operative creatinine, BMI, diabetes, COPD, or STS score between BC and DC before or after propensity matching. BC patients received both anterograde and retrograde cardioplegia in multiple doses while DC was delivered almost entirely anterograde with 95% (73/77) of patients receiving a single dose only. DC was associated with decreased CPB (108±24 vs 135±43 min; p=0.001) and aortic-cross clamp (80±16 vs 102±30 min; p=0.001) time and maximal glucose level during cardiopulmonary bypass [CPB] (165±39 vs 202±49 mg/dL; p=0.001) while troponin T level did not differ between DC and BC (0.3±0.29 vs 0.44±1.7 ng/ml; p=0.7). Pre-operative ejection fraction did not change in either BC (64±12% vs 61±10 %; p=0.09) or DC (58±14% vs 57±14%; p=0.4) after AVR.
CONCLUSIONS:
In minimally invasive AVR surgery, del Nido cardioplegia provided equivalent myocardial protection and clinical outcomes to blood cardioplegia while simplifying cardioprotective regimen and reducing aortic cross-clamp time. DC was associated with lower CPB glucose levels and demonstrated feasibility of single dose administration.
