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Comparison of Clinical Outcomes between del Nido Cardioplegia and Microplegia among Patients Undergoing Elective
Erhan Hafız1, Özgür Altınbaş2, Işık Betil Kutlu3
1Department of Cardiovascular Surgery, Gaziantep University Medical Faculty, 27410 Gaziantep, Turkey. erhhfz@gmail.com.
Insights
Del Nido cardioplegia offers advantages in mitral valve replacement, reducing cross-clamp and bypass times. Patients receiving del Nido cardioplegia experienced shorter intensive care stays and required less defibrillation, indicating improved efficiency and cost-effectiveness.
Area of Science:
- Cardiac Surgery
- Cardiology
- Anesthesiology
Background:
- Cardioplegia solutions protect the myocardium during cardiopulmonary bypass in cardiac surgery.
- Del Nido cardioplegia and microplegia are commonly used solutions.
- Mitral valve replacement is a frequent cardiac procedure requiring myocardial protection.
Purpose of the Study:
- To compare the efficacy and outcomes of del Nido cardioplegia versus microplegia in patients undergoing elective mitral valve replacement.
- To evaluate intraoperative and postoperative parameters, including myocardial protection and resource utilization.
Main Methods:
- A comparative study of 120 patients undergoing elective mitral valve replacement between 2018 and 2023.
- Patients were divided into two groups: del Nido cardioplegia (n=64) and microplegia (n=56).
- Preoperative characteristics, intraoperative/postoperative data, mortality, and intensive care costs were statistically analyzed.
Main Results:
- No significant differences in preoperative characteristics were observed between the groups.
- The del Nido group showed statistically significant reductions in cross-clamp time (45 vs. 57 min) and cardiopulmonary bypass time (56 vs. 65 min).
- Shorter intensive care length of stay (18.04 vs. 22.37 h) and reduced intraoperative defibrillation (5 vs. 13) were noted in the del Nido group, along with lower intensive care costs.
Conclusions:
- Both del Nido and microplegia are safe for mitral valve replacement.
- Del Nido cardioplegia demonstrates advantages in reducing intraoperative times and improving postoperative recovery.
- The use of del Nido cardioplegia may lead to decreased anesthesia exposure, infection risk, and enhanced cost-effectiveness.
Background:
Cardioplegia solutions are used to protect the myocardium from ischemic injury caused by cardiopulmonary bypass and various types of cardioplegia solutions have been introduced for cardiac surgery. In this study, we aimed to compare the effects of del Nido cardioplegia and microplegia, which were mostly used in our clinic for intraoperative and postoperative processes among patients who underwent elective mitral valve replacement. As a result, the comparison could be performed in a specific patient group without additional valvular or coronary disease, and cardioplegia distribution could be achieved more efficiently.
Methods:
Between 2018 and 2023, a total of 120 patients who underwent elective mitral valve replacement via sternotomy with del Nido cardioplegia or microplegia were included in the study. Patients were divided into two groups; group 1 (del Nido, n = 64) and group 2 (microplegia, n = 56). Preoperative characteristics, intraoperative and postoperative early clinical data as primary outcomes, and postoperative mortality rates and intensive care costs as secondary outcomes were compared statistically.
Results:
There were no statistically significant differences in terms of preoperative characteristics between the two groups. Duration of cross clamp differences between group 1 versus group 2 (45 ± 16 vs. 57 ± 19 min), cardiopulmonary bypass (56 ± 17 vs. 65 ± 21 min), intensive care length of stay (18.04 ± 7.41 vs. 22.37 ± 6.86 h), requirement of intraoperative defibrillation (n = 5 vs. n = 13), and intensive care costs were found to be statistically significantly lower in del Nido group.
Conclusion:
Either del Nido or microplegia solutions can be used safely in mitral valve replacement operations, however, del Nido cardioplegia has some advantages over intraoperative processes, such as lowering the cross clamp and cardiopulmonary bypass time. Furthermore, patients who received del Nido cardioplegia had shorter intensive care stay and required less intraoperative defibrillation compared with the microplegia group. Therefore, less exposure to anesthesia, the prevention of infection due to shortened operation duration, and greater cost-effectiveness can be achieved by using del Nido cardioplegia instead of microplegia.
