Original Article

Use of del Nido Cardioplegia for Adult Heart Surgery: How Long Is Not Too Long?

^* Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; ^‡ School of Medicine, National University of Ireland, Galway, Ireland; ^§ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
^† Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
^‖ Cardiovascular Research Institute, National University of Singapore, Singapore

Address correspondence to: Theo Kofidis MD, PD(Ger), FRCS, FAHA, FAMS, Head and Senior Consultant, Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital (NUH), National University Health System (NUHS), 1E Kent Ridge Road, Level 9, Singapore 119228, Singapore. E-mail: tkofidis@yahoo.com

Received: 14 April 2020
Accepted: 6 October 2020

Abstract

The most apparent practical advantage of del Nido cardioplegia (DNC) is that it allows the surgeon a longer arrest period before a subsequent dose is needed, as opposed to the conventional St. Thomas’ cardioplegia solution where the recommended ischemic time is ∼15–20 minutes. In this study, we explored the incidence of arrhythmia after cross-clamp removal as a surrogate for a safe myocardial ischemic time with the use of DNC in adult heart surgery. A total of 113 patients who had undergone heart valve repair and/or replacement surgery at the National University Hospital, Singapore, were investigated. This single-center retrospective study was conducted on a population where DNC had been used for myocardial protection between January 2017 and April 2019. Cardioplegia ischemic time interval groups were not significant predictors of postoperative arrhythmia, defibrillation, and intraoperative intra-aortic balloon pump usage. Crude comparison of postoperative outcomes showed no significant differences in any other postoperative variables, including mortality and total hospital stay. From the results of the present study, it appears that there is no optimal ischemic time interval for the administration of DNC within a 120-minute time period. It is likely that DNC has a redosing interval of, and may provide adequate myocardial protection, for up to 120 minutes.