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Del Nido cardioplegia in coronary surgery: a propensity-matched analysis
Alexander Schutz1,2, Qianzi Zhang3, Kimberly Bertapelle4
1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Insights
Del Nido cardioplegia (DNC) is a safe alternative to traditional blood-based cardioplegia for coronary artery bypass grafting (CABG). DNC use was associated with significantly lower rates of postoperative infections and dysrhythmia in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Cardiac Surgery
Background:
- Del Nido cardioplegia (DNC) is recognized for its safety in adult valve surgery with normal coronary arteries.
- Traditional blood-based cardioplegia (CC) is commonly used in coronary artery bypass grafting (CABG).
Purpose of the Study:
- To compare the efficacy and safety of DNC versus CC in patients undergoing CABG.
- To evaluate the impact of DNC on postoperative complications following CABG.
Main Methods:
- Retrospective analysis of 863 patients undergoing CABG between 2014 and 2017.
- Comparison of patients receiving DNC (n=420) versus CC (n=443).
- Propensity score-matching analysis was performed to control for confounding variables.
Main Results:
- No significant differences in cardiopulmonary bypass or aortic cross-clamp times between DNC and CC groups.
- DNC group showed significantly lower rates of overall infections (1.7% vs 4.3%) and sternal infections (0.9% vs 3.2%).
- DNC use was associated with reduced postoperative atrial fibrillation (23.8% vs 30.7%) and ventricular tachycardia (0.5% vs 3.4%).
Conclusions:
- Del Nido cardioplegia (DNC) is a safe and effective alternative to conventional cardioplegia in CABG patients.
- DNC is associated with decreased rates of postoperative infection and dysrhythmia.
- Further research into DNC's use in longer cardiac procedures is warranted due to its low complication profile.
Objectives:
Del Nido cardioplegia (DNC) has been shown to be safe in adults with normal coronary arteries who are undergoing valve surgery. This study compared the effects of DNC versus traditional blood-based cardioplegia on postoperative complications in patients who underwent coronary artery bypass grafting (CABG).
Methods:
A retrospective analysis was performed on 863 patients who underwent CABG with DNC (n = 420) or control cardioplegia (CC) (n = 443) between 2014 and 2017. The full cohort of DNC and CC recipients, as well as propensity score-matched pairs, was compared regarding preoperative risk variables and outcomes.
Results:
The DNC and CC groups showed no significant differences in mean cardiopulmonary bypass time (53.09 vs 52.10 min, P = 0.206) or aortic cross-clamp time (32.82 vs 33.28 min, P = 0.967). The groups also showed no difference in operative mortality (2.1% vs 2.5%, P = 0.734); however, DNC use resulted in lower rates of overall infections (1.7% vs 4.3%, P = 0.024), total sternal infections (0.9% vs 3.2%, P = 0.023), postoperative atrial fibrillation (23.8% vs 30.7%, P = 0.023) and postoperative ventricular tachycardia (0.5% vs 3.4%, P = 0.002). A propensity-matching analysis (n = 335 pairs) showed similar statistically significant decreases with DNC.
Conclusions:
In this large cohort of CABG patients, DNC was shown as a safe alternative to CC and was associated with lower postoperative dysrhythmia and infection rates. These findings show that DNC is safe and effective in patients whose operative interventions may require only single-dosing cardioplegia; its use in longer cases should be further explored given its low complication rate.
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