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Single-dose modified bloodless del Nido cardioplegia for minimally invasive cardiac surgery
Heemoon Lee1, Jihoon Kim2, Jae Suk Yoo1
1Department of Thoracic and Cardiovascular Surgery, Bucheon Sejong Hospital, Bucheon, Republic of Korea.
Background:
Recent studies demonstrated satisfactory results of del Nido cardioplegia in minimally invasive cardiac surgery (MICS). We aimed to evaluate the efficacy of our modified "bloodless" del Nido cardioplegia in MICS compared to the histidine-tryptophan-ketoglutarate (HTK) solution.
Methods:
We retrospectively reviewed 471 patients who underwent minimally invasive cardiac surgery (MICS) in our institution between January 2015 and September 2022. Patients were divided into HTK (n = 96) and bloodless del Nido (n = 375) groups. Using propensity score matching, we matched 72 patients with bloodless del Nido to 72 patients with HTK, based on demographic and operative information.
Results:
There were no significant differences in the baseline characteristics and operative data after matching. The early mortality and morbidities did not differ significantly between the two groups. Freedom from overall mortality did not differ significantly during the follow-up period (97.2% in HTK vs. 98.6 in bloodless del Nido at 2 years, P = 0.56). The two groups had no difference in postoperative lactate levels at 6 and 24 h. Various statistical methods consistently indicated that bloodless del Nido cardioplegia did not increase risks for overall mortality.
Conclusions:
The modified bloodless del Nido cardioplegia showed comparable postoperative outcomes in MICS compared with the HTK solution, suggesting its potential as an alternative option for MICS.
Insights
The modified bloodless del Nido cardioplegia offers comparable outcomes to the histidine-tryptophan-ketoglutarate (HTK) solution in minimally invasive cardiac surgery (MICS). This study found no increased risk of mortality or morbidity with the bloodless del Nido approach.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Minimally Invasive Procedures
Background:
- Del Nido cardioplegia has shown promise in minimally invasive cardiac surgery (MICS).
- The efficacy of a modified "bloodless" del Nido cardioplegia requires evaluation against standard solutions like histidine-tryptophan-ketoglutarate (HTK).
Purpose of the Study:
- To compare the efficacy and safety of a modified bloodless del Nido cardioplegia versus the HTK solution in MICS.
- To assess postoperative outcomes, including mortality and morbidity, in patients undergoing MICS with either cardioplegia solution.
Main Methods:
- Retrospective review of 471 MICS patients (January 2015 - September 2022).
- Patients were divided into HTK (n=96) and bloodless del Nido (n=375) groups.
- Propensity score matching created comparable groups of 72 patients each for analysis.
Main Results:
- No significant differences in baseline characteristics or operative data post-matching.
- Early mortality and morbidity rates were similar between the bloodless del Nido and HTK groups.
- Two-year freedom from overall mortality was comparable (98.6% vs. 97.2%), with no significant difference in postoperative lactate levels.
Conclusions:
- Modified bloodless del Nido cardioplegia demonstrates comparable postoperative outcomes to HTK in MICS.
- The bloodless del Nido approach is a potential alternative for MICS, without increasing mortality risks.
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