• The heart surgery forum · Sep 2020

    Myocardial Protection by Blood-Based Del Nido versus St. Thomas Cardioplegia in Cardiac Surgery for Adults and Children.

    • Ahmed Abdelrahman Elassal, Kkalid Al-Ebrahim, Osman Al-Radi, Zaher Faisal Zaher, Ahmed Mohamed Dohain, Gaser Abdelmohsen Abdelmohsen, Ahmed Hasan Abdulla, Mohamed Atia Meshak, Mahmoud Akl Abdulaziz, Mahmoud Salem Eldesouki, Mohamed Atef Hasan, and Osama Eldib.
    • Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, Saudi Arabia. samalassal1434@gmail.com.
    • Heart Surg Forum. 2020 Sep 24; 23 (5): E689-E695.

    BackgroundSt. Thomas (ST) and Del Nido (DN) cardioplegic solutions are widely used for myocardial protection during cardiac surgery. In 2016, our university hospital shifted from modified St. Thomas to Del Nido solution for both adult and pediatric cardiac surgery. This retrospective study was conducted to compare ST and DN solutions regarding surgical workflow and clinical outcome in pediatric and adult patients undergoing cardiac surgery.MethodsWe reviewed 220 patients who underwent cardiac surgery requiring cardioplegic arrest. Patients were categorized in 2 groups: ST (n = 110) and DN (n = 110). Each group included 60 pediatric and 50 adult patients. Demographic, intraoperative, and postoperative variables were collected.ResultsIn pediatric patients, no significant difference was found between the 2 groups regarding clamping time, bypass time, need for defibrillation, inotropic score, postoperative ejection fraction (EF), period of mechanical ventilation, intensive care unit stay, or postoperative arrhythmias. One patient in the ST group required mechanical support by extracorporeal membrane oxygenation. We had 5 cases of pediatric mortality (3 in DN and 2 in ST, P = .64). In adult patients, significantly fewer patients in the DN group needed defibrillation than in the ST group. No significant difference was found regarding clamping time, inotropic score, or intraaortic balloon pump use. Mortality in adult patients was 6 cases (4 in ST group and 2 in DN group).ConclusionDN cardioplegia solution is as safe as ST solution in pediatric and adult cardiac surgery. It has comparable results of myocardial protection and clinical outcome, with superiority regarding uninterrupted surgery and lower rate of defibrillation.

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