Modified Del Nido cardioplegia versus St.Thomas cardioplegia for myocardial protection in adult patients with combined valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Bo ,  CAO Yong , XIAN Minghai , LIN Fei , HU Lian , YU Guanshui , ZHANG Kaitian

Department of Cardiovascular Surgery, Gaozhou People's Hospital, Gaozhou, 525200, Guangdong, P.R.China;

Corresponding author：

CAO Yong, Email: wildness@163.com

Keywords：

Modified Del Nido cardioplegia; modified St. Thomas cardioplegia; combined valve replacement; myocardial protection

DOI：

10.7507/1007-4848.201702003

Video：

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Objective To analyze the effect of myocardial protection between modified Del Nido cardioplegia and St. Thomas Hospital Cardioplegia in adult patients with aortic valve and mitral valve replacement. Methods From January 2014 to June 2016, 140 patients underwent aortic valve and mitral valve replacement in our hospital. According to different cardioplegia, the patients were divided into two groups including a modified Del Nido cardioplegia group (70 patients, 37 males, 33 females at mean age of 53.13±9.52 years) and a St. Thomas cardioplegia group (70 patients, 32 males, 38 females, at age of 50.71±9.29 years). We collected clinical data of the patients before operation (T1), 2 h after aortic unclamping (T2), 24 h after operation (T3) and 48 h after operation (T4). Indexes of muscle enzymes including blood center creatine kinase (CK), creatine kinase isoenzyme (CK-MB) concentration and liver function indexes including urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations, and compared the postoperative and follow-up clinical data. Results There was no statistical difference in age, weight, gender, ejection fraction baseline data between the two groups (P>0.05). All patients were successfully completed combined valve replacement under cardiopulmonary bypass. The cardiopulmonary time was no statistical difference between the two groups (P>0.05). However, compared with St. Thomas cardioplegia group, modified Del Nido group was less in perfusion (1.19±0.39vs. 2.99±0.75, P<0.001), shorter in aortic clamping time (P=0.003). No statistical difference was found in defibrillation rate after resuscitation between the two groups (P=0.779). Biochemical indicators were not statistically different at different time points between the two groups (P>0.05). Conclusion Modified Del Nido cardioplegia has the same effect on myocardial protection with St. Thomas cardioplegia in adult patients. It reduces the frequency of reperfusion, and shortens the clamping time. There is no additional injury in the important organs such as liver, kidney. Modified Del Nido cardioplegia myocardial protection ability in adult heart valve surgery is feasible.

Citation： CHEN Bo, CAO Yong, XIAN Minghai, LIN Fei, HU Lian, YU Guanshui, ZHANG Kaitian. Modified Del Nido cardioplegia versus St.Thomas cardioplegia for myocardial protection in adult patients with combined valve replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(1): 58-62. doi: 10.7507/1007-4848.201702003 Copy

1.	Suleiman MS, Hancock M, Shukla R, et al. Cardioplegic strategies to protect the hypertrophic heart during cardiac surgery. Perfusion, 2011, 26(Suppl 1): 48-56.
2.	Zeng J, He W, Qu Z, et al. Cold blood versus crystalloid cardioplegia for myocardial protection in adult cardiac surgery: a meta-analysis of randomized controlled studies. J Cardiothorac Vasc Anesth, 2014, 28(3): 674-681.
3.	Sá MP, Rueda FG, Ferraz PE, et al. Is there any difference between blood and crystalloid cardioplegia for myocardialprotection during cardiac surgery? A meta-analysis of 5576 patients from 36 randomized trials. Perfusion, 2012, 27(6): 535-546.
4.	Ovrum E, Tangen G, Tollofsrud S, et al. Cold blood cardioplegia versus cold crystalloid cardioplegia:a prospective randomized study of 1440 patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2004, 128(6): 860-865.
5.	Kotani Y, Tweddell J, Gruber P, et al. Current cardioplegia practicein pediatric cardiac surgery: a north american multiinstitutional survey. Ann Thorac Surg, 2013, 96(3): 923-929.
6.	Matte GS, del Nido PJ. History and use of del Nido cardioplegia solution at Boston Children's Hospital. J Extra Corpor Technol, 2012, 44(3): 98-103.
7.	Heinemeyer D, Belles G, Stapenhorst K, et al. Intracellular pH measurement duringcardiac arrest in ventricular myocardium by Bretschneider's cardioplegic solution HTK and St.Thomas Hospital solution with and without procaine. Thorac Cardiovasc Surg, 1987, 35(1): 48-52.
8.	Scrascia G, Guida P, Rotunno C, et al. Myocardial protection during aortic surgery: comparison between Bretschneider-HTK and cold blood cardioplegia. Perfusion, 2011, 26(5): 427-433.
9.	Wang D, Savage C, Xiao S, et al. St.Thomas Hospital Cardioplegia #2 fails to suppress slow reaction pacemaker cell electrical activity. J Surg Res, 2004, 120(1): 56-63.
10.	Kim K, Ball C, Grady P, et al. Use of del Nido Cardioplegia for adult cardiac surgery at the cleveland clinic:perfusion implications. J Extra Corpor Technol, 2014, 46(4): 317-323.
11.	O'Blenes SB, Friesen CH, Ali A, et al. Protecting the aged heart during cardiac surgery: the potential benefits of del Nidocardioplegia. J Thorac Cardiovasc Surg, 2011, 141(3): 762-770.
12.	Najjar M, George I, Akashi H, et al. Feasibility and safety of continuou retrograde administration of Del Nido cardioplegia: a case series. J Cardiothorac Surg, 2015, 10: 176.
13.	Li JA, Liu YL, Liu JP, et al. Pulmonary artery perfusion with HTK solution prevents lung injury in infants after cardiopulmonary bypass. Chin Med J(Engl), 2010, 123(19): 2645-2650.
14.	Govindapillai A, Hua R, Rose R, et al. Protecting the aged heart during cardiac surgery: use of del Nido cardioplegia provides superior functional recovery in isolated hearts. J Thorac Cardiovasc Surg, 2013, 146(4): 940-948.
15.	Ota T, Yerebakan H, Neely RC, et al. Short-term outcomes in adult cardiac surgery in the use of del Nido cardioplegia solution. Perfusion, 2016, 31(1): 27-33.

1. Suleiman MS, Hancock M, Shukla R, et al. Cardioplegic strategies to protect the hypertrophic heart during cardiac surgery. Perfusion, 2011, 26(Suppl 1): 48-56.
2. Zeng J, He W, Qu Z, et al. Cold blood versus crystalloid cardioplegia for myocardial protection in adult cardiac surgery: a meta-analysis of randomized controlled studies. J Cardiothorac Vasc Anesth, 2014, 28(3): 674-681.
3. Sá MP, Rueda FG, Ferraz PE, et al. Is there any difference between blood and crystalloid cardioplegia for myocardialprotection during cardiac surgery? A meta-analysis of 5576 patients from 36 randomized trials. Perfusion, 2012, 27(6): 535-546.
4. Ovrum E, Tangen G, Tollofsrud S, et al. Cold blood cardioplegia versus cold crystalloid cardioplegia:a prospective randomized study of 1440 patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2004, 128(6): 860-865.
5. Kotani Y, Tweddell J, Gruber P, et al. Current cardioplegia practicein pediatric cardiac surgery: a north american multiinstitutional survey. Ann Thorac Surg, 2013, 96(3): 923-929.
6. Matte GS, del Nido PJ. History and use of del Nido cardioplegia solution at Boston Children's Hospital. J Extra Corpor Technol, 2012, 44(3): 98-103.
7. Heinemeyer D, Belles G, Stapenhorst K, et al. Intracellular pH measurement duringcardiac arrest in ventricular myocardium by Bretschneider's cardioplegic solution HTK and St.Thomas Hospital solution with and without procaine. Thorac Cardiovasc Surg, 1987, 35(1): 48-52.
8. Scrascia G, Guida P, Rotunno C, et al. Myocardial protection during aortic surgery: comparison between Bretschneider-HTK and cold blood cardioplegia. Perfusion, 2011, 26(5): 427-433.
9. Wang D, Savage C, Xiao S, et al. St.Thomas Hospital Cardioplegia #2 fails to suppress slow reaction pacemaker cell electrical activity. J Surg Res, 2004, 120(1): 56-63.
10. Kim K, Ball C, Grady P, et al. Use of del Nido Cardioplegia for adult cardiac surgery at the cleveland clinic:perfusion implications. J Extra Corpor Technol, 2014, 46(4): 317-323.
11. O'Blenes SB, Friesen CH, Ali A, et al. Protecting the aged heart during cardiac surgery: the potential benefits of del Nidocardioplegia. J Thorac Cardiovasc Surg, 2011, 141(3): 762-770.
12. Najjar M, George I, Akashi H, et al. Feasibility and safety of continuou retrograde administration of Del Nido cardioplegia: a case series. J Cardiothorac Surg, 2015, 10: 176.
13. Li JA, Liu YL, Liu JP, et al. Pulmonary artery perfusion with HTK solution prevents lung injury in infants after cardiopulmonary bypass. Chin Med J(Engl), 2010, 123(19): 2645-2650.
14. Govindapillai A, Hua R, Rose R, et al. Protecting the aged heart during cardiac surgery: use of del Nido cardioplegia provides superior functional recovery in isolated hearts. J Thorac Cardiovasc Surg, 2013, 146(4): 940-948.
15. Ota T, Yerebakan H, Neely RC, et al. Short-term outcomes in adult cardiac surgery in the use of del Nido cardioplegia solution. Perfusion, 2016, 31(1): 27-33.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Modified Del Nido cardioplegia versus St.Thomas cardioplegia for myocardial protection in adult patients with combined valve replacement

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