Cardiopulmonary bypass (CPB) relies on cardiac cardioplegia to maintain the beating heart and provide surgeons with a reversible bloodless surgical field of vision. Del Nido cardioplegia (DNC) is a type of cold blood cardioplegia
Cardiopulmonary bypass (CPB) relies on cardiac cardioplegia to maintain the beating heart and provide surgeons with a reversible bloodless surgical field of vision. Del Nido cardioplegia (DNC) is a type of cold blood cardioplegia with a greater potassium level. Professor Pedro Del Nido at the University of Pittsburgh first created it for usage in children's underdeveloped myocardium. Despite the above-mentioned findings, DNC's application in adult patients is currently limited. Because of its hazy benefits in preserving myocardium from ischemia, the Cleveland Clinic suggested using Del Nido solution only in valve procedures and not in coronary artery bypass surgeries. To determine the effect of DNC solution on the incidence of arrhythmia and myocardial protection in protecting the myocardium from postoperative arrhythmia, a retrospective study was conducted involving adult patients who underwent all cardiovascular surgeries via CPB in Nanjing First Hospital affiliated with Nanjing Medical University during the year of 2019 and evaluated the effect of DNC solution on the incidence of arrhythmia and myocardial protection in protecting the myocardium from postoperative arrhythmia.
Acute Physiology and Chronic Health Evaluation II (APACHE II), European system for cardiac operative risk evaluation score (euroSCORE), left ventricular ejection fraction (EF), biochemical indicators, data from the ECG on admission, and other perioperative variables were collected and recorded as baseline characteristics. Patients' intraoperative data were obtained based on medical record information such as surgery type, operation duration, CBP time, aortic occlusion time, and cardioplegia type. The patients were then divided into groups based on the type of cardioplegia they had. On-call clinicians administered case-specific therapies such as amiodarone, metoprolol, lidocaine, and other anti-arrhythmic or electro versions based on the physician's clinical judgment.
Patients in the 954 instances were initially categorized based on the type of heart surgery they had. A total of 442 individuals had their heart valves replaced, with 194 in the DNC group and 248 in the STH group. Coronary artery bypass grafting (CABG) was performed on 236 patients, including 38 cases in the DNC group and 198 cases in the STH group. Aortic aneurysm surgery was performed on 76 instances, including 25 cases in the DNC group and 51 cases in the STH group. Due to the small sample size, a total of 93 cases were classified as other categories, including surgical correction of congenital heart problems such as atrial septal defect repair, atrial myxoma resection, cardiac transplantation, and other treatments. The surgical techniques conducted by the STH and DNC groups differ significantly in terms of operation type, operation time, AB time, and CBP time. To rule out the effect of surgical techniques on postoperative ventricular arrhythmia, a propensity score-based analysis was done.
In a nutshell, DNC is a novel choice in cardiovascular surgery that can successfully minimize the incidence of ventricular arrhythmia, shorten the length of ICU stay, reduce perfusion frequency, and boost efficiency. Cardioplegia increases extracellular potassium concentration and decreases the potential difference between the cell's interior and outside potassium. To confirm the findings, more prospective research such as randomized controlled trials (RCTs) and cohort analyses are needed.
Shu C, Hong L, Shen X, Zhang W, Niu Y, Song X, Kong J, Zhang C. Effect of Del Nido cardioplegia on ventricular arrhythmias after cardiovascular surgery. BMC Cardiovasc Disord. 2021 Jan 13;21(1):32. doi: 10.1186/s12872-020-01844-z. PMID: 33441080; PMCID: PMC7805093.