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Antegrade Versus Continuous Retrograde del Nido Cardioplegia in the David I Operation
Xuan Jiang1, Tianxiang Gu1, Enyi Shi1
1Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.
Insights
Both antegrade and retrograde del Nido cardioplegia are safe for the David I operation. Retrograde delivery showed a higher rate of temporary heart block but lower lactate levels.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiothoracic Medicine
Background:
- The effectiveness of continuous retrograde del Nido cardioplegia for myocardial protection remains debated.
- This study investigates the hypothesis that antegrade and retrograde cardioplegia provide comparable safety in the David I procedure.
Purpose of the Study:
- To compare the safety and efficacy of antegrade versus retrograde del Nido cardioplegia in patients undergoing the David I operation.
- To evaluate myocardial protection strategies in aortic valve repair/replacement.
Main Methods:
- Retrospective review of 33 patients undergoing the David I operation.
- Comparison of outcomes between antegrade and retrograde del Nido cardioplegia administration.
- Follow-up duration ranged from 1 to 15 months.
Main Results:
- No hospital mortality or reoperation occurred in either group.
- Similar cardiopulmonary bypass, aortic clamp times, Troponin I, CKMB, LVEF, ventilation, ICU, and hospital stay durations were observed.
- The antegrade group had higher lactate levels (p=0.01), while the retrograde group showed a higher incidence of temporary atrioventricular block (26.7% vs 0%, p=0.019), with only one patient requiring a permanent pacemaker.
Conclusions:
- Both antegrade and retrograde del Nido cardioplegia are safe and effective for the David I operation.
- Continuous retrograde del Nido cardioplegia is associated with a higher incidence of temporary atrioventricular block, which typically resolves without permanent pacing.
- Retrograde delivery resulted in lower lactate levels compared to antegrade delivery.
Background:
The efficacy of continuous retrograde del Nido cardioplegia for myocardial protection is still controversial. We hypothesised that antegrade and retrograde cardioplegia offer equivalent safety for myocardial protection in the David I procedure.
Methods:
We retrospectively reviewed 33 patients undergoing the David I operation with antegrade or retrograde del Nido solution from June 2014 to January 2016. The outcomes were compared. The follow-up was 1 month to 15 months.
Results:
There was no hospital mortality or reoperation in both groups. Cardiopulmonary bypass, and aortic clamp times were similar. Troponin I level (TnI), creatine kinase level (CKMB), left ventricular ejection fraction (LVEF), ventilation times, intensive care unit (ICULOS) and hospital stay times (THLOS) were similar between the two groups. The lactate level was slightly higher (9.26±2.56 vs 7.17±1.58, p=0.01) in the antegrade group compared with the retrograde group. The incidence of heart block was higher (four patients) in the retrograde group (26.7% vs 0%, p=0.019). Only one patient (6.7%) required implantation of a permanent cardiac pacemaker.
Conclusion:
Antegrade and continuous retrograde del Nido cardioplegia can be used safely and effectively in the David I operation. The continuous retrograde del Nido cardioplegia is associated with a higher rate of temporary AV block which does not require permanent pacing, and a lower lactate level.
