A Game Changer for Low and Middle Income Countries: Del Nido Cardioplegia for Adult Cardiac Surgery – A Tertiary Care Experience

Document Type : Original Article

Authors

1 Department of Cardiothoracic and Vascular Surgery, GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India.

2 Department of Anesthesia, GCS Medical College, Hospital and Research Center, Ahmedabad, Gujarat, India.

3 Department of Orthodontics and Dentofacial Orthopedics, College of Dental Sciences, Amargarh, Bhavnagar, Gujarat, India.

Abstract

Introduction: Del Nido Cardioplegia (DNC) offers prolonged myocardial protection through a single-dose approach.
Methods: This retrospective study involved 175 adult patients from five surgical groups (DVR, MIS‑MVR, MVR via sternotomy, AVR, congenital repairs). Statistical analysis was conducted using SPSS v25. Quantitative variables were assessed using t‑tests /Mann–Whitney U tests, while categorical variables were analyzed using chi‑square/Fisher’s exact tests. Significant differences (p<0.05) in ACC and CPB durations were observed across the groups.
Results: The return to spontaneous sinus rhythm ranged from 90% to 100% among the groups. Significant variations in ACC and cardiopulmonary bypass (CPB) times were noted (p<0.05). Single‑dose DNC proved to be effective in all cases.
Conclusion: DNC demonstrates safety and efficiency in low- and middle-income country (LMIC) settings.

Keywords


  1.  Buckberg GD. Update on current techniques of myocardial protection. The Annals of thoracic surgery. 1995 Sep 1;60(3):805-14.
  2. Melrose DG, Dreyer B, Bentall HH, Baker JB. Elective cardiac arrest. The Lancet. 1955 Jul 2;266(6879):21-3.
  3. Jynge P, Hearse DJ, Feuvray D, Mahalu W, Canković-Darracott S, O'Brien K, et al. The St. Thomas' hospital cardioplegic solution: a characterization in two species. Scandinavian journal of thoracic and cardiovascular surgery. Supplementum. 1981 Jan 1;30:1-28.
  4. Matte GS, del Nido PJ. History and use of del Nido cardioplegia solution at Boston Children’s Hospital. The Journal of extracorporeal technology. 2012 Sep 1;44(3):98-103.
  5. Charette K, Gerrah R, Quaegebeur J, Chen J, Riley D, Mongero Let al. Single dose myocardial protection technique utilizing del Nido cardioplegia solution during congenital heart surgery procedures. Perfusion. 2012 Mar;27(2):98-103.
  6. Ad N, Holmes SD, Massimiano PS, Rongione AJ, Fornaresio LM, Fitzgerald D. The use of del Nido cardioplegia in adult cardiac surgery: a prospective randomized trial. The Journal of thoracic and cardiovascular surgery. 2018 Mar 1;155(3):1011-8.
  7. Likosky DS, Wu X, Fitzgerald DC, Haft JW, Paone G, Romano MA, et al. Evaluating changes in del Nido cardioplegia practices in adult cardiac surgery. The Journal of ExtraCorporeal Technology. 2020 Sep 1;52(3):173-81.
  8. Hibino N, Shin’oka T, Matsumura G, Ikada Y, Kurosawa H. The tissue-engineered vascular graft using bone marrow without culture. The Journal of Thoracic and Cardiovascular Surgery. 2005 May 1;129(5):1064-70.
  9. Yamamoto H, Yamamoto F. Myocardial protection in cardiac surgery: a historical review from the beginning to the current topics. General thoracic and cardiovascular surgery. 2013 Sep;61(9):485-96.
  10. Spiegel DA, Gosselin RA. Surgical services in low-income and middle-income countries. The Lancet. 2007 Sep 22;370(9592):1013-5.
  11. Ota T, Yerebakan H, Neely RC, Mongero L, George I, Takayama H, et al. Short-term outcomes in adult cardiac surgery in the use of del Nido cardioplegia solution. Perfusion. 2016 Jan;31(1):27-33.
  12. Garg SK, Rawat RS, Saad DA, Omar I. Del nido cardioplegia in adults: a retrospective observational study in comparison to modified St. Thomas cardioplegia in cardiac surgery. Journal of Cardiothoracic Surgery. 2024 Apr 25;19(1):266.
  13. Li C, Xiang H, Yang H, Liu W, Lan W, Luo C, et al. Del Nido cardioplegia versus cold blood cardioplegia in adult cardiac surgery: a meta-analysis of randomized clinical trials. Journal of cardiothoracic surgery. 2024 Jun 22;19(1):356.
  14. Lee S, Jung JC, Chang HW, Lee JH, Kim DJ, Kim JS, et al. Comparative analysis of del Nido cardioplegia versus blood cardioplegia in isolate coronary artery bypass grafting. Journal of Cardiothoracic Surgery. 2024 Jul 13;19(1):438.
  15. Szpytma M, Gimpel D, Ross J, Newland RF, Crouch G, Rice GD, et al. Outcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times. The Journal of ExtraCorporeal Technology. 2024 Dec 1;56(4):149-58.