Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea.
J Cardiothorac Surg. 2024 Jul 13;19(1):438. doi: 10.1186/s13019-024-02853-1.
This study examined the efficacy of del Nido cardioplegia compared with traditional blood cardioplegia in adult cardiac surgery for isolated coronary artery bypass grafting by evaluating the early postoperative outcomes.
A total of 119 patients who underwent isolated conventional coronary artery bypass grafting were enrolled and divided into two groups (del Nido cardioplegia group [n = 36] and blood cardioplegia group [n = 50]) based on the type of cardioplegia used. This study compared the preoperative characteristics, intraoperative data, and early postoperative outcomes. Further subgroup analyses were conducted for high-risk patient groups.
The 30-day mortality and morbidity rates were not significantly different between groups. The del Nido cardioplegia group exhibited advantageous myocardial protection outcomes, demonstrated by a significantly smaller rise in Troponin I levels post-surgery (2.8 [-0.4; 4.2] vs. 4.5 [2.9; 7.4] ng/mL, p = 0.004) and fewer defibrillation attempts during weaning off of cardiopulmonary bypass (0.0 ± 0.2 vs. 0.4 ± 1.1 times, p = 0.011) when compared to the blood cardioplegia group. Additionally, the del Nido group achieved a reduction in surgery duration, as evidenced by the reduced aortic cross-clamping time (64.0 [55.5; 75.5] vs. 77.5 [65.0; 91.0] min, p = 0.001) and total operative time (287.5 [270.0; 305.0] vs. 315.0 [285.0; 365.0] min, p = 0.008). Subgroup analyses consistently demonstrated that the del Nido cardioplegia group had a significantly smaller postoperative increase in Troponin I levels across all subgroups (p < 0.05).
del Nido cardioplegia provided myocardial protection and favorable early postoperative outcomes compared to blood cardioplegia, making it a viable option for conventional coronary artery bypass grafting. Establishing a consensus on the protocol for Del Nido cardioplegia administration in adult surgeries is needed.
本研究通过评估术后早期结果，比较了 Del Nido 心脏停搏液与传统含血心脏停搏液在成人心脏手术中单中心冠状动脉旁路移植术（CABG）中的疗效。
根据心脏停搏液类型，将 119 例行单纯常规 CABG 的患者分为两组（Del Nido 心脏停搏液组[n=36]和含血心脏停搏液组[n=50]）。本研究比较了两组患者的术前特征、术中数据和术后早期结果。对高危患者组进行了进一步的亚组分析。
两组 30 天死亡率和发病率无显著差异。Del Nido 心脏停搏液组术后肌钙蛋白 I 水平升高幅度较小（2.8[0.4；4.2] vs. 4.5[2.9；7.4]ng/ml，p=0.004），在心肺转流脱机过程中需要除颤的次数较少（0.0±0.2 vs. 0.4±1.1 次，p=0.011），心肌保护效果较好。此外，与含血心脏停搏液组相比，Del Nido 组手术时间缩短，主动脉阻断时间（64.0[55.5；75.5] vs. 77.5[65.0；91.0]min，p=0.001）和总手术时间（287.5[270.0；305.0] vs. 315.0[285.0；365.0]min，p=0.008）均减少。亚组分析一致表明，在所有亚组中，Del Nido 心脏停搏液组术后肌钙蛋白 I 水平升高幅度均较小（p<0.05）。
与含血心脏停搏液相比，Del Nido 心脏停搏液可提供心肌保护作用和良好的术后早期结果，是常规 CABG 的一种可行选择。需要在成人手术中建立关于 Del Nido 心脏停搏液管理的方案共识。
