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Del nido versus conventional blood cardioplegia in patients with obstructive hypertrophic cardiomyopathy
Yingshan Huang1, Shujie Yan2, Yi Song1
1Department of Cardiopulmonary Bypass, Yunnan Fuwai Cardiovascular Hospital, Kunming, China.
Insights
Del Nido cardioplegia (DNC) is safe and effective for hypertrophic obstructive cardiomyopathy surgery, similar to conventional blood cardioplegia (CBC). However, prolonged DNC infusion times may increase postoperative cardiac enzyme levels.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia
Background:
- Myocardial protection is critical during cardiopulmonary bypass in cardiac surgery.
- Del Nido cardioplegia (DNC), initially for pediatric use, is increasingly adopted for adult cardiac procedures.
- Efficacy of DNC in hypertrophic obstructive cardiomyopathy (HOCM) remains underreported.
Purpose of the Study:
- To evaluate the efficacy and safety of Del Nido cardioplegia (DNC) compared to conventional blood cardioplegia (CBC) in patients undergoing extended surgical myectomy for HOCM.
- To assess postoperative myocardial injury markers and clinical outcomes between the two cardioplegia strategies.
Main Methods:
- Retrospective analysis of elective patients undergoing extended surgical myectomy from September 2017 to June 2022.
- Patients were divided into Del Nido cardioplegia (DNC) and conventional blood cardioplegia (CBC) groups.
- Primary outcomes included postoperative high-sensitivity cardiac troponin I (hs-TnI) and creatine kinase-MB (CK-MB) levels; secondary outcomes encompassed various clinical and echocardiographic parameters.
Main Results:
- Fifty-nine patients (15 CBC, 44 DNC) were analyzed with no significant demographic differences or in-hospital mortality.
- The DNC group showed significantly lower total cardioplegia volume and infusion times, with a higher rate of return to spontaneous rhythm.
- Postoperative hs-TnI and CK-MB levels were comparable between groups, although longer DNC infusion intervals correlated with elevated CK-MB on postoperative days 1 and 2.
Conclusions:
- Del Nido cardioplegia (DNC) demonstrates comparable safety and efficacy to conventional blood cardioplegia (CBC) in extended surgical myectomy for HOCM.
- While DNC offers benefits in reduced volume and infusion time, infusion intervals exceeding 60 minutes may be associated with increased postoperative CK-MB levels.
Background:
Myocardial protection is essential in cardiac surgery with cardiopulmonary bypass The Del Nido cardioplegia which was initially used in pediatric cardiac surgery, has been increasingly used in adult cardiac surgery recently. However, no literature has reported the efficacy of DNC in hypertrophic obstructive cardiomyopathy.
Methods:
This retrospective study involved elective patients who underwent extended surgical myectomy with or without concomitant cardiac surgical procedures between September 2017 and June 2022. Patients were distributed into two groups, the DNC and the CBC group. The primary outcome was high-sensitivity cardiac troponin I (hs-TnI) and creatine kinase-MB (CK-MB) levels at the 0, 1, and 2 postoperative days. The secondary outcomes contained: intraoperative LVEF, return to spontaneous rhythm; postoperative myocardial infarction, worsening or deteriorating of EF, mechanical circulatory support; new-onset atrial fibrillation; mechanical ventilation duration; intensive care unit hours; in-hospital days.
Results:
Fifty-nine patients were included and divided into the CBC (n = 15) and the DNC group (n = 44). There was no statistical difference in patients' demographics and preoperative parameters between the two groups. No in-hospital mortality. The total cardioplegia volume [21.93(18.36,26.07) vs. 25.68(23.17,37.12), p = 0.012] and infusion times [1(1,1) vs. 2(2,3), p = 0.000] were less and the incidence of return to spontaneous rhythm after declamping was higher in the DNC group [97.7% vs. 73.3%, p = 0.013]. Postoperative hs-TnI and CK-MB levels were comparable between the two groups. A longer DNC infusion interval was associated with higher levels of CK-MB on postoperative day 1 and day 2 (p = 0.009 and p = 0.011, respectively).
Conclusions:
The use of DNC in extended surgical myectomy procedure was as safe and effective as CBC. However, DNC infusion interval over 60 minutes was associated with increased postoperative CK-MB levels.
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