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The del Nido versus cold blood cardioplegia in aortic valve replacement: A randomized trial

Krzysztof Sanetra1, Witold Gerber1, Rajesh Shrestha1

  • 11st Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland; Center for Cardiovascular Research and Development, American Heart of Poland, Bielsko-Biała, Poland.

The Journal of Thoracic and Cardiovascular Surgery
|July 31, 2019
PubMed

Insights

The del Nido (DN) cardioplegia protocol, requiring a single infusion, showed a significant reduction in ventricular fibrillation during reperfusion compared to cold blood (CB) cardioplegia in aortic valve replacement patients. DN cardioplegia is a viable alternative for cardiac protection.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Cardioprotection

Background:

  • Aortic valve replacement (AVR) necessitates effective myocardial protection strategies.
  • Traditional cold blood (CB) cardioplegia requires multiple infusions during ischemic durations.
  • The del Nido (DN) cardioplegia solution offers a single-infusion approach for potential improved cardioprotection.

Purpose of the Study:

  • To compare the cardioprotective efficacy of single-infusion del Nido (DN) cardioplegia versus multi-infusion cold blood (CB) cardioplegia.
  • To evaluate primary endpoints including electrical cardiac activity, ventricular fibrillation, and myocardial injury markers (troponin, CK-MB).

Main Methods:

  • A randomized trial involving 150 patients undergoing AVR.
  • Patients were assigned to either the del Nido (DN) cardioplegia group (infusion every 90 minutes) or the cold blood (CB) cardioplegia group (infusion every 20-30 minutes or upon observed cardiac activity).
  • Primary endpoints assessed were intraoperative electrical activity, post-reperfusion ventricular fibrillation, and postoperative cardiac enzyme levels at 24 and 48 hours.

Main Results:

  • No significant difference in electrical cardiac activity during crossclamp between DN and CB groups (39.7% vs 45.3%, P=1.0).
  • Significantly lower incidence of ventricular fibrillation post-reperfusion in the DN group (22.7%) compared to the CB group (54.7%, P=.001).
  • Trend towards lower postoperative troponin and CK-MB levels in the DN group, although not statistically significant.

Conclusions:

  • The del Nido cardioplegia protocol is a safe and effective alternative to cold blood cardioplegia for patients undergoing aortic valve replacement.
  • DN cardioplegia demonstrates a significant advantage in reducing ventricular fibrillation during the critical reperfusion phase.
Abstract

Keywords:
aortic valve replacementcardioplegiacold blood cardioplegiadel Nidoischemia-reperfusion injury

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