1. Re-dosing of del Nido cardioplegia in adult cardiac surgery requiring prolonged aortic cross-clamp
- Author
-
James Beck, Alex M. D'Angelo, Alexander P. Kossar, Koji Takeda, Michael Argenziano, Isaac George, Paul Kurlansky, Vinayak Bapat, Yoshifumi Naka, Craig R. Smith, Jessica Spellman, Hiroo Takayama, Samantha Nemeth, and Catherine Wang
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Cardiac function curve ,medicine.medical_specialty ,medicine.medical_treatment ,Pilot Projects ,Ventricular Function, Left ,Interquartile range ,medicine ,Clinical endpoint ,Humans ,Cardiac Surgical Procedures ,Cardioplegic Solutions ,Stroke ,Dialysis ,Aged ,Retrospective Studies ,business.industry ,Stroke Volume ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Cardiac surgery ,Aortic cross-clamp ,Anesthesia ,Heart Arrest, Induced ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES Few data exist on the use of del Nido cardioplegia in adults, specifically during operations requiring prolonged aortic cross-clamp. In this pilot study, we evaluate outcomes of patients undergoing surgery with cross-clamp time >3 h based on re-dosing strategy, using either full dose (FD; 1:4 blood to crystalloid ratio) or dilute (4:1 blood to crystalloid ratio) solution. METHODS Consecutive adult patients (>18 years) undergoing cardiac surgery from 2012 to 2018 with cross-clamp time >3 h were reviewed. Patients were excluded if del Nido cardioplegia was not used. Patients were categorized into FD or dilute groups based on re-dosing solution. Propensity score matching was used to control for baseline differences between groups. The primary endpoint was in-hospital mortality. Other outcomes examined included: postoperative mechanical support, arrhythmia, stroke, dialysis and cardiac function. RESULTS Included for analysis were 173 patients (115 male) with median age of 63.8 (interquartile range 53.9–73.1). Major comorbidities included diabetes (45), cerebrovascular disease (34), hypertension (131), atrial fibrillation (52) and previous cardiac surgery (83). There were 108 patients (62%) who received FD re-dosing, while 65 (38%) received dilute. A greater proportion of patients in the dilute group received retrograde delivery, for both induction (32/108 vs 39/65, P CONCLUSIONS Del Nido cardioplegia has been used in complex cardiac surgery requiring prolonged cross-clamp. Re-dosing can be performed with either FD or dilute del Nido solution with no statistical difference in outcomes.
- Published
- 2021
- Full Text
- View/download PDF