Hawkins Robert B, Stewart James W, Wu Xiaoting, Goldberg Joshua, Fitzgerald David, DeLucia Alphonse, Graebner Brittney, Willekes Charles, Pagani Francis D, Nieter Donald H, Likosky Donald S, Ailawadi Gorav
Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
Department of Surgery, Michigan Medicine, Ann Arbor, Mich; Department of Surgery, Yale School of Medicine, New Haven, Conn.
J Thorac Cardiovasc Surg. 2024 Dec;168(6):1687-1697.e5. doi: 10.1016/j.jtcvs.2023.09.057. Epub 2023 Oct 2.
The use of del Nido cardioplegia in adult cardiac surgery is rising in popularity. The objective of this large multicenter study was to evaluate the use and associated outcomes of del Nido versus blood cardioplegia in adult cardiac surgery.
Patients undergoing coronary artery bypass grafting (CABG) and/or valve (mitral, aortic), and/or nondescending thoracic aortic surgery (July 2014 to March 2022) across 39 centers were extracted from the Perfusion Measures and Outcomes registry. Patients were stratified by cardioplegia type for unadjusted analysis and multivariable mixed-effects models were used for risk adjustment.
Of 44,175 patients, 42.5% used del Nido, with use increasing 48% over time. Overall, the del Nido group had shorter median crossclamp time (74 minutes vs 87 minutes, P < .001) and lower median peak intraoperative glucose levels (161 mg/dL vs 180 mg/dL, P < .001). Use of del Nido was not associated with operative mortality (adjusted odds ratio [OR], 1.16; P = .075) nor major morbidity (OR, 1.05; P = .25). Findings for valve cases were similar, except crossclamp time differences were variable by type of valve procedure. Within the CABG subgroup there was a trend toward increased operative mortality with del Nido (OR, 1.24; P = .069), whereas the risk of renal failure approaches statistical significance in the aortic subgroup (OR, 1.54; P = .056).
In this large, multicenter study, the use of del Nido was associated with variable crossclamp time differences, lower intraoperative glucose levels, and no significant difference in major morbidity or mortality. Efficiency benefits of del Nido may be limited in valve cases, whereas outcomes in CABG and aortic cases warrant further study.
在成人心脏手术中，德尔尼多停搏液的使用越来越普遍。这项大型多中心研究的目的是评估德尔尼多停搏液与血液停搏液在成人心脏手术中的使用情况及相关结果。
从灌注措施与结果登记处提取2014年7月至2022年3月期间在39个中心接受冠状动脉旁路移植术（CABG）和/或瓣膜（二尖瓣、主动脉瓣）和/或非降主动脉手术的患者。按停搏液类型对患者进行分层以进行未调整分析，并使用多变量混合效应模型进行风险调整。
在44175例患者中，42.5%使用了德尔尼多停搏液，其使用量随时间增加了48%。总体而言，德尔尼多停搏液组的中位主动脉阻断时间较短（74分钟对87分钟，P <.001），术中血糖峰值中位数较低（161mg/dL对180mg/dL，P <.001）。使用德尔尼多停搏液与手术死亡率（调整优势比[OR]，1.16；P =.075）或主要并发症（OR，1.05；P =.25）无关。瓣膜病例的结果相似，只是主动脉阻断时间差异因瓣膜手术类型而异。在CABG亚组中，使用德尔尼多停搏液有手术死亡率增加的趋势（OR，1.24；P =.069），而在主动脉亚组中，肾衰竭风险接近统计学意义（OR，1.54；P =.056）。
在这项大型多中心研究中，使用德尔尼多停搏液与主动脉阻断时间差异可变、术中血糖水平较低以及主要并发症或死亡率无显著差异相关。德尔尼多停搏液的效率优势在瓣膜病例中可能有限，而CABG和主动脉病例的结果值得进一步研究。
