Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Pediatrics, Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia.
Heart Surg Forum. 2020 Sep 24;23(5):E689-E695. doi: 10.1532/hsf.3099.
St. 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.
We 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.
In 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).
DN 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.
托马斯（ST）和德尔尼多（DN）心脏停搏液在心脏手术中被广泛用于心肌保护。2016 年，我们的大学医院在成人和儿科心脏手术中从改良的托马斯溶液转为使用德尔尼多溶液。本回顾性研究旨在比较 ST 和 DN 溶液在接受心脏手术的儿科和成年患者中的手术流程和临床结果。
我们回顾了 220 例需要心脏停搏的心脏手术患者。患者分为 2 组：ST（n=110）和 DN（n=110）。每组包括 60 例儿科患者和 50 例成人患者。收集了人口统计学、术中及术后变量。
在儿科患者中，两组间的夹闭时间、体外循环时间、除颤需求、正性肌力评分、术后射血分数（EF）、机械通气时间、重症监护病房停留时间或术后心律失常无显著差异。ST 组中有 1 例患者需要体外膜肺氧合机械支持。我们有 5 例儿科死亡（DN 组 3 例，ST 组 2 例，P=0.64）。在成人患者中，DN 组需要除颤的患者明显少于 ST 组。夹闭时间、正性肌力评分或主动脉内球囊泵使用无显著差异。成人患者的死亡率为 6 例（ST 组 4 例，DN 组 2 例）。
DN 心脏停搏液在儿科和成人心脏手术中与 ST 溶液一样安全。它具有相似的心肌保护和临床结果，手术中断少，除颤率低。
