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Utilization of del Nido Cardioplegia in Adult Coronary Artery Bypass Grafting
Christian T. O'Donnell1, Phat L. Tran2, Andrew B. Goldstone2, Shari Miller2, Paul E. Shuttleworth2, Jack H. Boyd2.
1Stanford University School of Medicine, Stanford, CA, USA, 2Stanford University Medical Center, Stanford, CA, USA.

OBJECTIVE:Del Nido cardioplegia (DN) was developed in the 1990s to reduce ischemia-reperfusion injury in pediatric hearts, however its use has since expanded to adult cardiac surgery. There has been limited research regarding DN in adult cardiac surgery and even less in coronary artery bypass grafting (CABG). This study investigates the surgical outcomes of the single-dose DN cardioplegia vs the conventional multi-dose blood cardioplegia (BC) in CABG patients.
METHODS: A retrospective analysis of 81 consecutive isolated CABG patients at a single center by a single surgeon was performed. The initial 27 patients (October 2014- July 2015) received anterograde BC and the subsequent 54 patients (August 2015- August 2016) received anterograde DN. In addition, propensity score matching using nearest-neighbor matching with bias correction identified 74 matches between the DN (n= 51) vs. BC (n= 23) groups for analysis.
RESULTS: Clinical outcomes including: length of hospital stay, intensive care unit stay, 30-day incidence of readmission, stroke, myocardial infarction and death did not differ between the cohorts. Measures of cardiac function showed equivalent myocardial preservation with DN (Table 1). Mean aortic cross-clamp time was significantly reduced in the DN group compared to the BC group (p = 0.006): 74 ± 16 min vs 87 ± 20 min. Mean cardiopulmonary bypass (CPB) time was also significantly reduced with DN (p = 0.011): 98 ± 22 min vs 114 ± 27 min; even though the average number of repaired vessels did not differ between the DN group (3.06 ± 0.81) and the BC group (3.00 ± 0.68). Cohen’s d effect size predicts the reduced cross-clamp and CPB times to have a moderate to high practical significance. Defibrillations needed after cardioplegic arrest were also significantly reduced with DN (p = 0.030): 7/54 patients vs 9/27 patients. Propensity matched analysis confirmed the significant reduction in cross-clamp time, CPB time, and defibrillations with DN (Table 1).
CONCLUSIONS: Single dose, antegrade DN cardioplegia can provide comparable myocardial preservation and equivalent clinical outcomes in CABG patients with a shorter surgical time than BC. Larger clinical trials are warranted to determine more potential benefits to this technique.

Table 1: Surgical Factors and Cardiac Outcomes
Unmatched AnalysisPropensity Matched Analysis
Surgical FactorsBC(n=27)DN(n=54)p-ValueBC(n=23)DN(n=51)p- Value
Repaired Vessels3.003.060.742.963.020.51
Cross-Clamp Time (min)87.3774.430.00687.0472.900.004
CPB Time (min)114.4898.260.011111.6195.880.01
Cardiac Outcomes
Left Ventricular Ejection Fraction53.0055.510.4351.9655.440.31
Right Ventricular Function Decreased1/250/520.331/230/510.53
Atrial Fibrillation (30 day)4/2712/540.563/2312/510.191

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Endorsed by:
The Society of Thoracic Surgeons

Co-sponsored by:
Association of Physician Assistants in Cardiovascular Surgery (APACVS) The International Society for Minimally Invasive Cardiothoracic Surgery Japanese Association for Coronary Artery Surgery
Brazilian Society of Cardiovascular Surgery Fu-Wai Hospital of Beijing Indian Association of Cardiovascular-Thoracic Surgeons
Society for Cardiothoracic Surgery in Great Britain & Ireland