title: Assessing the safety of del Nido cardioplegia solution in adult congenital cases.
abstract: OBJECTIVE
  del Nido cardioplegia solution (CPS) has been successfully used for myocardial protection in the pediatric population. We propose this solution can be used safely in adult congenital patients. The proposed benefit of this solution is the avoidance of the need for repetitive interruption of the operation to administer multiple doses of standard cardioplegia.
  
  
  METHODS
  As part of a quality improvement initiative, 47 consecutive adult patients (mean age 40.9 years, range 18-71) undergoing congenital heart surgery were given del Nido CPS. Cardiac function was assessed pre- and post-operatively by echocardiography (ECHO). Inotrope use, troponin levels and restoration of cardiac rhythm were also evaluated.
  
  
  RESULTS
  The average duration of the longest ischemic time was 52.5 minutes ± 15.57 minutes. In patients receiving a single dose (40%, n=19) of CPS, the average ischemic time was 49.8 minutes ± 18.8 minutes. No patients demonstrated any ventricular electrical activity while the aorta was cross-clamped. Post-operative ECHO showed that 94% (n=44) had no change in ejection fraction from the pre-operative ECHO. Patients requiring inotropic support at the time of leaving the operating room (OR) was 43% (n=20). The percentage of patients requiring inotropic support twenty-four hours post-operatively was 17% (n=8). Spontaneous restoration of cardiac rhythm (without the need for defibrillation) after cross-clamp removal occurred in 91% (n=43) of patients. The average troponin T level post-op was 1.86 ± 2.9 µg/L.
  
  
  CONCLUSIONS
  del Nido CPS can be used for myocardial protection during adult congenital cardiac surgery without any apparent adverse effects. In addition, we were able to change our re-dosing protocol to 45 minutes with del Nido CPS compared to 20 minutes with our adult 4:1 blood CPS.
authors.affiliation: Duke Children's Hospital, Duke University Hospital, Durham, NC, USA Smigl001@mc.duke.edu.
authors.forename: G
authors.initials: G
authors.lastname: Smigla
authors.affiliation: Duke Children's Hospital, Duke University Hospital, Durham, NC, USA.
authors.forename: R
authors.initials: R
authors.lastname: Jaquiss
authors.affiliation: Duke Children's Hospital, Duke University Hospital, Durham, NC, USA.
authors.forename: R
authors.initials: R
authors.lastname: Walczak
authors.affiliation: Duke Children's Hospital, Duke University Hospital, Durham, NC, USA.
authors.forename: D
authors.initials: D
authors.lastname: Bonadonna
authors.affiliation: Duke Children's Hospital, Duke University Hospital, Durham, NC, USA.
authors.forename: D
authors.initials: D
authors.lastname: Kaemmer
authors.affiliation: Duke Children's Hospital, Duke University Hospital, Durham, NC, USA.
authors.forename: C
authors.initials: C
authors.lastname: Schwimer
authors.affiliation: Duke Children's Hospital, Duke University Hospital, Durham, NC, USA.
authors.forename: A
authors.initials: A
authors.lastname: Lodge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D002314:Cardioplegic Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008875:Middle Aged; D014336:Troponin / Q000097:blood
chemical_list: D002314:Cardioplegic Solutions; D002316:Cardiotonic Agents; D014336:Troponin
keywords: adult congenital; cardioplegia; del Nido; ischemic time; myocardial protection