R. Ou1, A. Zhu1, A. Ashfaq1, S. Nguyen1, S. Riazati1, R. Satou1, R. J. Shemin1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Division Of Cardiac Surgery,Los Angeles, CA, USA
Introduction: The Buckberg blood cardioplegia has become the conventional solution for myocardial preservation during cadioplegic arrest. Recently, the del Nido cardioplegia solution has been utilized in pediatric cardiac operations and utilizes lidocaine rather than potassium to achieve diastolic arrest. Compared to conventional Buckberg cardioplegia it has the added benefit of only requiring one dose for up to 180 minutes of myocardial quiescence. By lowering cardioplegia volume, the del Nido method may reduce myocardial edema, hemodilution, arrhythmias and costs of care. In this study, we aimed to evaluate the safety and efficacy of del Nido cardioplegia in adult cardiac valvular operations.
Methods: The institutional Society of Thoracic Surgeons database was used to identify all adults undergoing aortic or mitral valve operations from January 2011 to May 2015. Patient demographics, operative characteristics and postoperative outcomes were gathered from the database as well as electronic medical records. Patients who received the del Nido solution (DN) were matched with those receiving conventional blood cardioplegia (CC) for procedure type as well as baseline characteristics such as age, gender, ejection fraction, diabetes, lung disease, among others. Statistical analysis was performed with STATA software (StataCorp, College Station) and P-values less than 0.05 were considered significant.
Results: During the study period, 54 patients met criteria and were included in the DN group while another 54 were assigned to the CC group after matching for baseline characteristics. The groups did not differ significantly in comorbid conditions as shown in Table 1. Compared to the CC group, DN patients exhibited a shorter crossclamp time (122 minutes vs 125 minutes, P= 0.87), higher in-hospital ICU length of stay (98 hours vs 96 hours, P= 0.59), mortality rate (9.3% vs 1.8%, P= 0.10), red cell transfusions (1.9 units vs 1.6 units, P=0.74) and readmission rates (13.2% vs 5.6%, P= 0.18). The fall in hematocrit immediately after the operation was similar between the DN (7.3%) and CC (7.9%) cohorts (P=0.63). Inotrope use between DN and CC measured by a Vasoactive Inotropic Score were also similar in the intraoperative period (7.3 vs 6.1, P=0.54) and postoperative period (2.4 vs 3.1, P=0.73).
Conclusion: Our data, although preliminary, suggests that the of del Nido cardioplegia solution was associated with a non-significant increase in mortality, readmission rate, ICU hours, and red cell transfusions. Given major differences in mechanism of action, the del Nido solution needs to be further evaluated in larger cohorts and include analysis of clinical as well echocardiographic outcomes.
