| Issue |
J Extra Corpor Technol
Volume 56, Number 4, December 2024
|
|
|---|---|---|
| Page(s) | 149 - 158 | |
| DOI | https://doi.org/10.1051/ject/2024029 | |
| Published online | 20 December 2024 | |
Original Article
Outcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times★
1
Cardiothoracic Surgical Unit, Division of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
2
Perfusion Service, Cardiothoracic Surgical Unit, Division of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
3
College of Medicine and Public Health, Flinders University
4
Quality and Outcomes Unit, Cardiothoracic Surgical Unit, Division of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
* Corresponding author: rob.baker@sa.gov.au; flinderscardiothoracicresearch@sa.gov.au
Received:
19
February
2024
Accepted:
25
September
2024
Background: The utility and uptake of Del Nido cardioplegia in adult cardiac surgery is rapidly increasing. Cases with prolonged aortic cross-clamp times necessitate multi-dosing however an understanding of safe ischaemic times and definitive guidelines in this domain are lacking. Therefore, this study aimed to assess the safety and efficacy of our DNC strategy by comparing post-operative troponin profiles and clinical outcomes between Del Nido and hyperkalaemic cardioplegia for cases with aortic cross-clamp times of greater than 90 min. Methods: A single-centre, retrospective cohort study at Flinders Medical Centre and Flinders Private Hospital of patients undergoing composite cardiac surgery with a cross-clamp time longer than 90 min. Data was prospectively collected from the Flinders Cardiac Surgery Registry from June 2014 to December 2022. A propensity-matched (1:1) analysis was performed comparing patients receiving Del Nido cardioplegia (n = 194) to those receiving hyperkalemic blood cardioplegia (n = 194). The primary outcome was the postoperative troponin release profile with clinical events reported as secondary outcomes. Results: There was no difference in the peak or median troponin at 6, 12 and 72 h nor the number of patients with positive troponin profiles postoperatively between cohorts. There was no difference in clinical outcomes between groups with aortic cross-clamp times of 90 min which remained true in sensitivity analysis extending out to 120 min. The Del Nido cohort received less cardioplegia volume (p < 0.001) and were more likely to return to spontaneous rhythm (p < 0.002). Conclusion: Del Nido cardioplegia for anticipated aortic cross-clamp times of greater than 90 min provided equivocal post-operative troponin profiles and clinical outcomes compared to multidose hyperkalemic blood cardioplegia.
Key words: Troponin / Del Nido / Cardioplegia / Hyperkalemic
© The Author(s), published by EDP Sciences, 2024
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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