Use of del Nido cardioplegia in adult cardiac surgery

Year 2022, Volume: 8 Issue: 1, 139 - 144, 04.01.2022

Bişar Amaç , Mümün Selçuk Semra Bölükbaş Fatma Kahraman Ahmet Kağan As , Muhammed Savran Orhan Güvenç , Mehmet Tuğrul Göncü , Mesut Engin , Senol Yavuz

https://doi.org/10.18621/eurj.970465

Cited By: 1

Abstract

In most adult cardiac surgery operations, the heart must be completely immobile and isolated from the blood. Therefore, the heart is stopped in diastole and a still operative site is obtained. Cardiac arrest results in ischemia-reperfusion injury. For these reasons, myocardial protection and the prevention of damages are required. Various cardioplegia solutions are used for this purpose. It can be said that cardioplegia is the gold standard method of myocardial protection in cardiac arrest. Nowadays, "Single-dose cardioplegia" applications are increasingly used, especially in minimally invasive cardiac surgery and basic coronary bypass procedures due to the advantages they provide, which include reduction of aortic cross-clamp time, prevention of frequent interruption of the procedure due to cardioplegia, and reduced postoperative myocardial dysfunction incidence. The two main solutions used in single dose cardioplegia applications are the Bretschneider solution and the del Nido extracellular cardioplegia solution. The del Nido cardioplegia solution (dNCS), which was originally developed for use in pediatric cardiac surgery, has recently increased its use in adult cardiac surgery due to straightforward application and long-term effectiveness. The del Nido cardioplegia reduces the aortic cross clamp duration, cardiopulmonary bypass time and required cardioplegia solution volume, and is a safer and superior cardioplegia solution and technique in terms of myocardial protection with regards to many organs and cardiac-biochemical parameters.

Keywords

Del Nido Cardioplegia, Adult Cardiac Surgery, Myocardial Protection, Cardioplegia, Cardiopulmonary Bypass

References

• 1. Chambers DJ. Mechanisms and alternative methods of achieving cardiac arrest. Ann Thorac Surg 2003;75:S661-6.
• 2. Yamamoto H, Yamamoto F. Myocardial protection in cardiac surgery: a historical review from the beginning to the current topics. Gen Thorac Cardiovasc Surg 2013;61:485-96.
• 3. Ferguson ZG, Yarborough DE, Jarvis BL, Sistino JJ. Evidence-based medicine and myocardial protection–where is the evidence? Perfusion 2017;21:30-5.
• 4. Braathen B, Jeppsson A, Scherste´n H, Hagen OM, Vengen Ø, Rexius H, et al. One single dose of histidine-tryptophan-ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood cardioplegia: a prospective randomized study. J Thorac Cardiovasc Surg 2011;141:995-1001.
• 5. Dobson GP, Jones MW. Adenosine and lidocaine: a new concept in nondepolarizing surgical myocardial arrest, protection, and preservation. J Thorac Cardiovasc Surg 2004;127:794-805.
• 6. Gorgy A, Shore-Lesserson L. Del Nido cardioplegia should be used in all adults undergoing cardiac surgery: Con. J Cardiothorac Vasc Anesth 2019; 33:1791-4.
• 7. Talwar S, Bhoje A, Sreenivas V, Makhija N, Aarav S, Choudhary SK, et al. Comparison of del Nido and St Thomas cardioplegia solutions in pediatric patients: a prospective randomized clinical trial. Semin Thorac Cardiovasc Surg 2017;29:366‐74.
• 8. Ramani J, Malhotra A, Wadhwa V, Garg P, Tarsaria M, Pandya H. Single-dose lignocaine based blood cardioplegia in single valve replacement patients. Braz J Cardiovasc Surg 2017;32:90-5.
• 9. Melrose DG, Dreyer B, Bentall HH, Baker JB. Elective cardiac arrest. Lancet 1955;269:21-2.
• 10. del Nido PJ, Cao Danh H, Sommers KE, Ohkado A. An aqueous heart preservation and cardioplegia solution. Chem Abstr 1995;123:29054 (US Patent 5,407,793, Apr 18, 1995).
• 11. Spratt JR, Guleserian KJ, Shumway SJ. Historical perspectives of the American Association for Thoracic Surgery: Pedro J. del Nido. J Thorac Cardiovasc Surg 2017;153:225-7.
• 12. Matte GS, del Nido PJ. History and use of del Nido cardioplegia solution at Boston Children's Hospital. J Extra Corpor Technol 2012;44:98-103.
• 13. Sanetra K, Pawlak I, Cisowski M. Del Nido cardioplegia - what is the current evidence? Kardiochir Torakochirurgia Pol 2018;15:114‐8.
• 14. Marieb EN, Hoehn K, Cardiac Muscle Fibers, In: S. Beauparlant (Ed), Human Anatomy & Physiology, Ninth Edition Pearson, Boston. 2013: p. 671-74.
• 15. Maxwell SRJ, Lip GYH. Reperfusion injury: a review of the pathophysiology, clinical manifestations and therapeutic options. Int J Cardiol 1997;58:95-117.
• 16. Park JL, Lucchesi BR. Mechanisms of myocardial reperfusion injury. Ann Thorac Surg 1999;68:1905-12.
• 17. Vinten-Johansen J. Whole blood cardioplegia: do we still need to dilute? J Extra Corpor Technol 2016;48:P9-P14.
• 18. Durandy YD. Is there a rationale for short cardioplegia re-dosing intervals? World J Cardiol 2015;7:658‐64.
• 19. Comentale G, Giordano R, Palma G. Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the "arm-wrestling"? J Thorac Dis 2018;10:714-7.
• 20. Orak Y, Kocarslan A, Boran OF, Acıpayam M, Eroglu E, Kirisci M, et al. Comparison of the operative and postoperative effects of del Nido and blood cardioplegia solutions in cardiopulmonary bypass surgery. Braz J Cardiovasc Surg 2020;35:689-96.
• 21. Timek T, Willekes C, Hulme O, Himelhoch B, Nadeau D, Borgman A, et al. Propensity matched analysis of del Nido cardioplegia in adult coronary artery bypass grafting: initial experience with 100 consecutive patients. Ann Thorac Surg 2016;101:2237-41.
• 22. Kantathut N, Cherntanomwong P, Khajarern S, Leelayana P. Lactated Ringer's as a base solution for del Nido cardioplegia. J Extra Corpor Technol 2019;51:153‐9.
• 23. Luo W, Bouhout I, Demers P. The del Nido cardioplegia in adult cardiac surgery: reinventing myocardial protection? J Thorac Dis 2019;11(Suppl 3):S367-9.
• 24. Eris C, Engin M, Erdolu B, Kagan As A. Comparison of del Nido cardioplegia vs blood cardioplegia in adult aortic surgery is the single-dose cardioplegia technique really advantageous? Asian J Surg. 2021 Oct 11. doi: 10.1016/j.asjsur.2021.09.032.
• 25. Sanrı US, Özsin KK, Toktaş F, Yavuz Ş. Comparison of Del Nido cardioplegia and blood cardioplegia in terms of development of postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting. Braz J Cardiovasc Surg 2021;36:158-64.
• 26. Gambardella I, Gaudino MFL, Antoniou GA, Tranbaugh RF, Nappi F, Girardi LN. Single versus multidose cardioplegia in adult cardiac surgery patients: a meta-analysis. J Thorac Cardiovasc Surg 2020;160:1195-1202.e12.
• 27. Mukdad L, Toppen W, Sanaiha Y, Mantha A, Bland S, Shemin R, et al. Incidence of cerebral microemboli in single-dose vs. multidose cardioplegia in adult cardiac surgery. J Extra Corpor Technol 2018;50:143‐8.
• 28. An KR, Rahman IA, Tam DY, Ad N, Verma S, Fremes SE, et al. A systematic review and meta-analysis of del Nido versus conventional cardioplegia in adult cardiac surgery. Innovations (Phila) 2019;14:385-93.
• 29. Kim K, Ball C, Grady P, Mick S. Use of del Nido cardioplegia for adult cardiac surgery at the Cleveland Clinic: perfusion implications. J Extra Corpor Technol 2014;46:317-23.
• 30. Valooran GJ, Nair SK, Chandrasekharan K, Simon R, Dominic C. del Nido cardioplegia in adult cardiac surgery--scopes and concerns. Perfusion 2016;31:6-14.
• 31. Lazar HL. Commentary: del Nido cardioplegia-the jury is still out and a new trial is needed. J Thorac Cardiovasc Surg 2020 Sep 18. doi: 10.1016/j.jtcvs.2020.09.053.
• 32. Lackner TE, Baldus D, Butler CD, Amyx C, Kessler G. Lidocaine stability in cardioplegic solution stored in glass bottles and polyvinyl chloride bags. Am J Hosp Pharm 1983;40:97-101.
• 33. Pereira LM, Matte GS, Lutz P, Arnold A, Patterson A. Production standard and stability of compounded del Nido Cardioplegia Solution. Hosp Pharm 2017;52:766-73.
• 34. Křížek T, Kozlík P, Hodek O, Štěpánová E, Nesměrák K. Lidocaine adsorption to ethylenevinyl acetate infusion bags decreases its availability in del Nido cardioplegia solution. Monatsh Chem 2020;151:1217-23.