Cold modified Del Nido cardioplegia in adults undergoing elective cardiac coronary surgery

Abstract

Introduction: The cardioplegic solution of Kirklin (Kn) is frequently used in adult cardiosurgical patients. It requires reinfusion at short intervals, which causes further difficulty during surgery and the quality of myocardial protection is often called into question. Aim: To demonstrate whether the modified cardioplegia of del Nido (MDN) with a longer period of cardiac arrest provides sufficiently effective and reliable myocardial protection when compared to the classic cardioplegia of Kirklin we use in our institution. Materials and methods: This ambispective clinical-epidemiological study was conducted in the Department of Heart Surgery at St Anna University Hospital in Sofia between January 2017 and September 2021. Using a random number generator, а hundred and twenty patients were selected and divided into two cohorts of 60 patients each. After further data processing, an additional five patients dropped out of the Kirklin group due to a ‘beating heart’ operative technique. As a result, the groups were divided as follows: 1) intermittent cardioplegia Kirklin (Kn, n=55) used in patients between January 2017 and June 2019, and 2) modified del Nido cardioplegia (MDN, n=60) used from June 2019 to September 2021. Results: In this study, we present our experience with MDN cardioplegia in patients undergoing isolated CABG and compare it with a group of patients who received Kn cardioplegia. The difference in cross-clamp and CPB times is due to the individual qualities and experience of surgeons. When using MDN, the longer intraoperative times not only showed no deterioration in postoperative results, did not increase the need of using an additional dose of cardioplegia, but also did not materialize in a statistically significant difference. The MDN cardioplegia showed significantly less usage of inotropic support (p<0.001) and IABP (p=0.029). Creatinine phosphokinase MB fraction when patients are admitted to intensive care was significantly less in the Kirklin group (p=0.045). Conclusions: Results suggest that the routine use of modified cardioplegic protection of del Nido in adult patients may be safe, leads to comparable clinical outcomes and could accelerate the surgical process. The reduced incidence in intra- and postoperative complications like DC shocks, arrhythmia, myocardial infarction, multiorgan failure and in-hospital mortality should be further studied, as it may imply superiority of myocardial protection with the modified solution.