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Cardioplegia strategy in isolated CABG: a comparative evaluation of del Nido, microplegia and St. Thomas II
Mustafa Akdi1, Sinan Sabit Kocabeyoğlu1, Ümit Kervan1
1Department of Cardiovascular Surgery, University of Health Sciences, Ankara Bilkent City Hospital, 06800, Cankaya, Ankara, Turkey.
Insights
Del Nido and microplegia cardioplegia solutions offer effective myocardial protection during coronary artery bypass grafting (CABG), showing better biochemical preservation than St. Thomas II. Del Nido provides practical benefits without increasing patient risk.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia Solutions
Background:
- The optimal cardioplegia strategy for adult coronary artery bypass grafting (CABG) is debated.
- Myocardial protection during CABG is crucial for patient outcomes.
Purpose of the Study:
- To compare the efficacy of del Nido, microplegia, and St. Thomas II cardioplegic solutions.
- To evaluate myocardial protection using clinical, biochemical, and echocardiographic parameters in isolated CABG.
Main Methods:
- Prospective single-center study of 157 adult patients undergoing isolated CABG.
- Patients were grouped by cardioplegia strategy: del Nido (n=88), microplegia (n=32), and St. Thomas II (n=37).
- Evaluated intraoperative variables, postoperative biomarkers, organ function, echocardiography, and clinical outcomes.
Main Results:
- Del Nido used less cardioplegia volume and doses.
- St. Thomas II had shorter cross-clamp times but more intraoperative defibrillation and adrenaline needs.
- Del Nido showed significantly lower troponin I and CK-MB levels postoperatively.
- Microplegia demonstrated the least pronounced LVEF decline.
- ICU and hospital stays were longer with St. Thomas II; morbidity and mortality were comparable.
Conclusions:
- Del Nido and microplegia provide effective myocardial protection in CABG.
- Both del Nido and microplegia offer superior biochemical preservation compared to St. Thomas II.
- Del Nido cardioplegia presents practical advantages without compromising safety.
Objective:
The optimal cardioplegia strategy in adult coronary artery bypass grafting (CABG) remains controversial. This study compared the efficacy of del Nido, microplegia, and St. Thomas II cardioplegic solutions for myocardial protection using clinical, biochemical, and echocardiographic parameters in isolated CABG.
Methods:
In this prospective single-center study, 157 adult patients undergoing isolated CABG were grouped according to cardioplegia strategy: del Nido (n = 88), microplegia (n = 32), and St. Thomas II (n = 37). Baseline demographic, laboratory, and echocardiographic characteristics were comparable. Intraoperative variables included cross-clamp (XC) and cardiopulmonary bypass (CPB) times, cardioplegia characteristics, defibrillation requirement, and vasoactive support. Postoperative assessment comprised arterial blood gas values, cardiac biomarkers, organ function tests, echocardiographic findings, clinical outcomes, and in-hospital mortality.
Results:
Total cardioplegia volume and number of doses were significantly lower in the del Nido group (p < 0.001). XC time was shorter with St. Thomas II (p < 0.001), likely due to operative technique differences. Intraoperative defibrillation and adrenaline requirement were more frequent in the St. Thomas II group (p = 0.001 and p = 0.027). Postoperative arterial blood gas parameters and end-organ function were similar. The del Nido group demonstrated significantly lower 1-h troponin I, 1-h CK-MB, and 24-h troponin I levels compared with St. Thomas II (p = 0.002, p = 0.004, p = 0.013). Postoperative increases in troponin I and CK-MB were also lower with del Nido. LVEF decline was least pronounced in the microplegia group (p = 0.013). ICU and hospital stays were significantly longer with St. Thomas II (p = 0.034 and p = 0.027). Morbidity and in-hospital mortality were comparable.
Conclusion:
Del Nido cardioplegia and microplegia provide comparable and effective myocardial protection, both demonstrating superior biochemical preservation compared with St. Thomas II. Del Nido offers practical advantages without increasing morbidity or mortality.
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