Redosing of long acting cardioplegic solutions in adult cardiac surgery: A comparative study

Area of Science:

• Cardiovascular Surgery
• Cardioplegia
• Myocardial Protection

Background:

• Limited data exists on redosing long-acting cardioplegia for prolonged aortic cross-clamp times in adults.
• This study addresses the need for evidence-based redosing strategies in complex cardiac procedures.

Purpose of the Study:

• To evaluate the outcomes of different cardioplegia redosing compositions in adult cardiac surgery patients requiring prolonged aortic cross-clamp times.
• To compare the efficacy of del Nido and Histidine-Tryptophane-Ketoglutarate cardioplegia with various redosing strategies.

Main Methods:

• A prospective randomized pilot study involving 288 adult cardiac surgery patients with expected cross-clamp times >60 minutes.
• Patients received either del Nido or Histidine-Tryptophane-Ketoglutarate (HTK) cardioplegia, with subgroups analyzed based on redosing methods: Cold Whole Blood (CWB) or St. Thomas Solution.
• Outcomes were compared between groups, focusing on troponin levels, respiratory support, and atrial fibrillation incidence.

Main Results:

• Redosing with Cold Whole Blood (CWB) in conjunction with del Nido (DN-CWB) or HTK cardioplegia resulted in significantly lower troponin levels compared to del Nido control.
• The DN-CWB group showed significantly reduced respiratory support time and incidence of atrial fibrillation compared to the del Nido control group.
• Initial success was observed with multiple redosing strategies, though patient populations were small.

Conclusions:

• Long-acting cardioplegia redosing strategies, particularly with Cold Whole Blood, show initial promise for managing prolonged aortic cross-clamp times in adult cardiac surgery.
• Further investigation is warranted to optimize redosing methods due to the small patient cohort.
• This study highlights the potential of various strategies for myocardial protection during extended cardiac procedures.