Comparison between Del Nido and conventional blood cardioplegia in pediatric open-heart surgery.
Floh AA, Das S, Haranal M, Laussen PC, Crawford-Lean L, Fan CS, Mertens LL, Runeckles K, Honjo O.Perfusion. 2022 Feb 10:2676591211054978. doi: 10.1177/02676591211054978. Online ahead of print.PMID: 35143733
Take Home Points:
- Del Nido cardioplegia provides equivalent myocardial protection compared to blood cardioplegia.
- Although, right ventricular dysfunction was more seen in patients having Del Nido cardioplegia, this did not have impact on clinical outcome, such as hospital mortality and use of ECMO.
Commentary from Dr. Yasuhiro Kotani (Okayama, Japan), chief section editor of Congenital Heart Surgery Journal Watch:
Single center retrospective study included 1534 patients having congenital cardiac surgery. Patients were divided into 2 groups: conventional blood cardioplegia (N=997) and Del Nido cardioplegia (N=537). Primary outcome was defined as a new postoperative more than moderate systemic ventricular dysfunction by echocardiogram. Secondary outcome was any severity of systemic ventricular dysfunction and right ventricular dysfunction. Surgical complexity was comparable between the groups. Cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time in Del Nido group were significantly longer (CPB: 117 vs. 108 min, p=0.04, ACC: 83 vs. 76 min, p=0.03), but the dose of cardioplegia was less in Del Nido group (2 vs. 3, p<0.001). Occurrence of systemic ventricular dysfunction was similar between the groups. Clinical outcomes, including hospital length of stay (p=0.07), postoperative ECMO (p=0.63), and hospital death (p=0.07) were comparable between the groups.
This study performed a comparison between Del Nido cardioplegia and conventional blood cardioplegia in high-volume center in North America. This is a single center, retrospective study but includes various complexity from neonates to small children which values this study compared to previous studies. Although Del Nido cardioplegia was introduced in 2015 in this institution and used nearly exclusively thereafter, both groups have similar surgical complexity and consistent surgical team, making this comparison reasonable. This study showed no difference in newly developed postoperative more than moderate systemic ventricular dysfunction between the groups which is not surprising. Interesting finding of the study is that Del Nido group had more right ventricular dysfunction compared to conventional cardioplegia group. The author’s speculation is that impairment of right ventricular function can be result from surgical duration (CPB and ACC time) not from source of cardioplegia. Theoretically, optimal myocardial protection in the right ventricle is difficult in the setting of congenital heart diseases. Patients may have right ventricular hypertrophy and abnormal coronary circulation in addition to general disadvantages, such as difficulty of temperature control compared to the left ventricle, etc. Further study focused on the distribution of cardioplegia in the right ventricle during cardiac arrest will answer the question.