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Del Nido vs. Cold Blood Cardioplegia for High-Risk Isolated Coronary Artery Bypass Grafting in Patients with Reduced
Krzysztof Sanetra1,2, Witold Gerber2,3, Marta Mazur4
1Division of Cardiovascular Surgery, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.
Insights
Del Nido cardioplegia offers effective myocardial protection for high-risk patients with reduced ejection fraction undergoing coronary bypass surgery. This study found similar outcomes and biomarker release compared to traditional cold blood cardioplegia.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia Solutions
Background:
- Evidence for del Nido cardioplegia in high-risk patients with reduced ejection fraction undergoing coronary artery bypass grafting (CABG) is limited.
- Optimizing myocardial protection in this vulnerable patient population is crucial for improving surgical outcomes.
Purpose of the Study:
- To compare the efficacy and safety of del Nido cardioplegia versus traditional cold blood cardioplegia in patients with ejection fraction < 40% undergoing isolated CABG.
- To evaluate perioperative outcomes, including biomarker release, cardiac function, and adverse events.
Main Methods:
- A retrospective analysis of an institutional database for isolated CABG procedures in patients with ejection fraction < 40%.
- Propensity score matching was used to create comparable groups receiving either del Nido (Group 1) or cold blood (Group 2) cardioplegia.
- Key outcomes assessed included biomarker levels (troponin, creatine kinase), ejection fraction changes, mortality, stroke, myocardial infarction, and major adverse cardiac and cerebrovascular events.
Main Results:
- 45 matched pairs of patients were analyzed; baseline characteristics were similar.
- A significantly higher rate of spontaneous sinus rhythm return was observed after cross-clamp release in the del Nido group (80% vs. 48.9%, P=0.003).
- No significant differences were found in troponin or creatine kinase levels at 12 hours, perioperative mortality, myocardial infarction, stroke, or major adverse cardiac and cerebrovascular events. Trends favored del Nido for creatine kinase at 36 hours and lower atrial fibrillation rates.
Conclusions:
- Del Nido cardioplegia demonstrates satisfactory myocardial protection in high-risk patients with reduced ejection fraction undergoing isolated coronary artery bypass surgery.
- The study suggests comparable safety and efficacy to cold blood cardioplegia, with a potential benefit in early rhythm restoration.
- Further prospective trials are warranted to confirm these findings and elucidate long-term benefits.
Introduction:
The evidence for using del Nido cardioplegia protocol in high-risk patients with reduced ejection fraction undergoing isolated coronary surgery is insufficient.
Methods:
The institutional database was searched for isolated coronary bypass procedures. Patients with ejection fraction < 40% were selected. Propensity matching (age, sex, infarction, number of grafts) was used to pair del Nido (Group 1) and cold blood (Group 2) cardioplegia patients. Investigation of biomarker release, changes in ejection fraction, mortality, stroke, perioperative myocardial infarction, composite endpoint (major adverse cardiac and cerebrovascular events), and other perioperative parameters was performed.
Results:
Matching allowed the selection of 45 patient pairs. No differences were noted at baseline. After cross-clamp release, spontaneous sinus rhythm return was observed more frequently in Group 1 (80% vs. 48.9%; P=0.003). Troponin values were similar in both groups 12 and 36 hours after surgery, as well as creatine kinase at 12 hours. A trend favored Group 1 in creatine kinase release at 36 hours (median 4.9; interquartile range 3.8-9.6 ng/mL vs. 7.3; 4.5-17.5 ng/mL; P=0.085). Perioperative mortality, rates of myocardial infarction, stroke, or major adverse cardiac and cerebrovascular events were similar. No difference in postoperative ejection fraction was noted (median 35.0%; interquartile range 32.0-38.0% vs. 35.0%; 32.0-40.0%; P=0.381). There was a trend for lower atrial fibrillation rate in Group 1 (6.7% vs. 17.8%; P=0.051).
Conclusion:
The findings indicate that del Nido cardioplegia provides satisfactory protection in patients with reduced ejection fraction undergoing coronary bypass surgery. Further prospective trials are required.
