L. Mukdad1, S. Barajas1, K. Kim1, W. Toppen1, R. Gevorgyan2, H. Laks1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Cardiac Surgery,Los Angeles, CA, USA 2University Of California – Los Angeles,Los Angeles, CA, USA
Introduction: Cerebral microemboli have been associated with neurocognitive deficits after cardiac operations using cardiopulmonary bypass (CPB). Interventions by the perfusionist and alterations in flow account for a large proportion of previously unexplained microemboli. This study compared the incidence of microemboli during cardiac operations using conventional (multi-dose) and Del Nido (single-dose) cardioplegia delivery.
Methods: Transcranial Doppler ultrasonography was used to detect microemboli in bilateral middle cerebral arteries of 14 adult patients undergoing cardiac operations using cardiopulmonary bypass and aortic clamping. Multi-dose cardioplegia (MDC) was used in 6 patients and single-dose cardioplegia (SDC) in the remaining 8. Manual count of microemboli during cross-clamp and during administration of cardioplegia was performed. Data were analyzed using STATA 13.0 statistical software (StataCorp, College Station, TX). Categorical variables were analyzed by Fisher’s exact test and continuous variables were analyzed by the independent sample T-test for unequal sample size. An alpha of < 0.05 was considered statistically significant.
Results: Baseline preoperative characteristics were similar between groups as shown in table 1. There were no differences in the ascending aortic atheroma grade (1.2 ± 0.4 MDC vs 1.6 ± 0.7 SDC, p=0.20), bypass times (141 ± 36 min MDC vs. 171 ± 33 min SDC, p=0.18), and cross-clamp times (118 ± 32 min MDC vs. 108 ± 45 min SDC, p=0.31). Use of multi-dose cardioplegia was associated with a seven-fold increase in the number of microemboli per minute of cross-clamp time (1.65 ± 1 vs 0.24 ± .18 emboli/min SDC, p=0.002).
Conclusion: In this prospective pilot study, we found that the use of single-dose cardioplegia led to fewer cerebral microemboli when compared to the traditional multi-dose approach. This finding deserves further investigation to evaluate the benefits of single-dose delivery vs potential reduction in myocardial protection.
