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Outcomes of coronary artery bypass surgery using modified del Nido cardioplegia in patients with poor ventricular
Samuel Brown1, Kholoud Nassar1, Jacob Razzouk1
1Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman Pavilion, Suite 21121, 11175 Campus Street, Loma Linda, CA, 92354, USA.
Insights
del Nido cardioplegia (DN) is safe for patients with low ejection fraction undergoing coronary artery bypass grafting. Short-term outcomes were similar to conventional cardioplegia (CCP), showing DN as a viable alternative.
Area of Science:
- Cardiology
- Cardiac Surgery
- Anesthesiology
Background:
- del Nido cardioplegia (DN) is recognized for its safety in adult patients with normal left ventricular ejection fraction undergoing isolated coronary artery bypass grafting (CABG).
- The safety and efficacy of DN in patients with diminished left ventricular function (LVEF ≤ 40%) remained to be determined.
Purpose of the Study:
- To evaluate the safety and short-term outcomes of del Nido cardioplegia (DN) compared to conventional cardioplegia (CCP) in adult patients with low left ventricular ejection fraction (LVEF ≤ 40%) undergoing isolated coronary artery bypass grafting (CABG).
Main Methods:
- A retrospective analysis of 272 adult patients with LVEF ≤ 40% who underwent isolated CABG between January 2019 and July 2022.
- Patients were divided into two groups based on surgeon preference: conventional cardioplegia (CCP) and del Nido cardioplegia (DN). Off-pump and beating heart procedures were excluded.
- Baseline characteristics, intraoperative data, and short-term postoperative outcomes were compared between the CCP and DN groups.
Main Results:
- No significant differences were observed in baseline characteristics, including mean LVEF (CCP: 32.5 ± 7.4% vs. DN: 33.4 ± 7.29%, p=0.939).
- The DN group showed a significantly shorter bypass time (113.20 ± 37.2 min vs. 122.43 ± 34.3 min, p=0.043), with no significant differences in urgency, number of grafts, ischemic time, or blood transfusion rates.
- Postoperative outcomes were similar between groups, including atrial fibrillation incidence (12.2% vs. 8.8%, p=0.403), ICU length of stay (3.7 ± 2.3 vs. 4.3 ± 3.7 days, p=0.886), total length of stay (5.7 ± 3.7 vs. 6.3 ± 4.4 days, p=0.922), and 30-day mortality (3.85% vs. 1.10%, p=0.205).
Conclusions:
- del Nido cardioplegia (DN) demonstrates equivalent short-term outcomes compared to conventional cardioplegia (CCP) in patients with low left ventricular ejection fraction undergoing isolated coronary artery bypass grafting.
- DN is a safe and effective alternative to CCP for this patient population, offering comparable clinical results.
Background:
del Nido cardioplegia (DN) has been shown to be safe in adult patients undergoing isolated coronary artery bypass grafting with normal left ventricular ejection fraction. We sought to determine whether it was also safe in adult patients with diminished left ventricular function.
Methods:
All patients with preoperative left ventricular ejection fraction ≤ 40% undergoing isolated coronary artery bypass grafting between 1/1/2019 and 7/10/2022 were retrospectively analyzed. Off-pump and beating heart cases were excluded. Patients were divided by surgeon preference between conventional cardioplegia (CCP) and DN. Baseline and intraoperative characteristics and short-term postoperative outcomes were compared.
Results:
Six surgeons performed 829 isolated coronary artery bypass operations during the study. Two-hundred seventy-two met study criteria. Three surgeons used exclusively CCP for the duration of the study, two used exclusively DN and one switched from CCP to DN mid-way through. Group totals were: CCP n = 181 and DN n = 91. There were no significant differences in baseline characteristics including mean left ventricular ejection fraction (CCP 32.5 ± 7.4% vs. DN 33.4 ± 7.29%, p = 0.939). Other than a significant decrease in bypass time for DN (113.20 ± 37.2 vs. 122.43 ± 34.3 min, p = 0.043) there were no intergroup differences in urgency, number of grafts, ischemic time or incidence of blood transfusion. Postoperative outcomes between CCP and DN were similar including incidence of atrial fibrillation (12.2% vs. 8.8%, p = 0.403), intensive care length of stay (3.7 ± 2.3 vs. 4.3 ± 3.7 days, p = 0.886), total length of stay (5.7 ± 3.7 vs. 6.3 ± 4.4 days, p = 0.922) and 30-day mortality (3.85% vs. 1.10%, p = 0.205).
Conclusion:
Compared to conventional cardioplegia, del Nido cardioplegia provides equivalent short-term outcomes in patients with low left ventricular ejection fraction undergoing isolated coronary artery bypass grafting.
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