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Del Nido cardioplegia versus blood cardioplegia in coronary artery bypass grafting

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

The del Nido cardioplegia (DC) has been extensively used in congenital heart surgery for over two decades and is becoming popular in adult cardiac surgery. We evaluated the efficacy and safety of DC, compared to conventional blood cardioplegia (BC), in adult patients undergoing isolated coronary artery bypass grafting (CABG).

Methods

This metachronous study included a total of 2330 consecutive patients who underwent isolated CABG. The study population was divided into two groups: BC group, consisting of 1165 patients (May 2012 through December 2015); and DC (del Nido) cardioplegia group consisting of 1165 patients (January 2016 through June 2018). Propensity matching yielded 735 well-matched pairs. The propensity-matched cohorts of BC and DC were compared in terms of myocardial function outcomes and other clinical outcomes to determine the efficacy and safety of both the cardioplegic solutions.

Results

There was no difference in 30-day mortality [odds ratio (OR), 0.74; 95% confidence interval (CI), 0.16–3.35, p = 0.70]. There was a significant decrease in the DC group in the postoperative events, including re-exploration rates [OR, 0.25; 95% CI, 0.118–0.568, p < 0.001], myocardial infarction [OR, 0.282; 95% CI, 0.133–0.596, p < 0.001], left ventricular dysfunction [OR, 0.60; 95% CI, 0.396–0.916, p = 0.018], and acute kidney injury (AKI) [OR, 0.255; 95% CI, 0.156–0.418, p < 0.001]. The rate of spontaneous return to sinus rhythm was significantly higher in the DC group [OR, 5.162; 95% CI, 3.701–7.198, p < 0.001]. Cardiopulmonary bypass time (95.2 ± 29.1 min vs. 82.1 ± 28.8 min, p < 0.001) and aortic cross-clamp (ACC) time (57.3 ± 19 min vs. 48.7 ± 19.0 min, p < 0.001) were higher in the DC group, but the absolute difference in ACC time was only 8 min. There was no difference in AKI requiring renal replacement therapy [OR, 0.62; 95% CI, 0.203–1.912, p = 0.40], postoperative cerebrovascular accidents [OR, 0.398; 95% CI, 0.077–2.059, p = 0.073], and postoperative ventricular arrhythmias [OR, 0.80; 95% CI, 0.456–1.916, p = 0.47].

Conclusion

This study revealed comparable clinical outcomes and effective myocardial protection with DC, compared to BC in patients undergoing isolated CABG. In addition, DC demonstrated the ease of administration with the feasibility of single-dose administration.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Prashanthi Beri M.Sc. (Clinical Research), Clinical Coordinator, Sajja Heart Foundation, Hyderabad, India, for the help in preparing the manuscript.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Star Hospitals, Road No. 10, Banjara Hills, Hyderabad, 500034, Telangana, India

    Lokeswara Rao Sajja, Gopichand Mannam, SatyaBhaskara Raju Dandu, Satyendranath Pathuri & Krishnamurthy Venkata Satya Siva Saikiran

  2. Division of Clinical Research in Cardiovascular Medicine/Surgery, Sajja Heart Foundation, Srinagar Colony, Hyderabad, 500073, India

    Lokeswara Rao Sajja & Devanish Narasimhasanth Kamtam

  3. Division of Statistics, Sajja Heart Foundation, Srinagar Colony, Hyderabad, 500073, India

    Balakrishna Nagalla

  4. Division of Anesthesiology, Star Hospitals, Road No. 10, Banjara Hills, Hyderabad, 500034, India

    Sriramulu Sompalli

  5. Department of Perfusion Technology, Star Hospitals, Road No. 10, Banjara Hills, Hyderabad, 500034, India

    Satyanarayana Ghanta

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  1. Lokeswara Rao Sajja
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Correspondence to Lokeswara Rao Sajja.

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Ethics committee approval

Approved by the institutional ethics committee with the reference no: IEC number: SH/RS/IEC/2021–2022/1002.

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The need for informed consent from the patient was waived off due to the retrospective nature of this report.

Human and animal rights statement

This study complies with the principles of the Declaration of Helsinki and did not have any experimentation with animals.

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Sajja, L.R., Mannam, G., Kamtam, D.N. et al. Del Nido cardioplegia versus blood cardioplegia in coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 40, 33–41 (2024). https://doi.org/10.1007/s12055-023-01584-7

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