title: del Nido versus Buckberg cardioplegia in adult isolated valve surgery.
abstract: BACKGROUND
  del Nido solution is a non-glucose-based, single-dose cardioplegic solution with few data supporting its safety in adults. We hypothesized that it and Buckberg solution offer myocardial protection of equivalent safety for isolated adult valve surgery.
  
  
  METHODS
  Adult patients undergoing primary isolated aortic or mitral valve surgery with del Nido or Buckberg solution from January 2010 to September 2013 were 1:1 propensity matched (85 aortic valve, 110 mitral valve), and outcomes were compared.
  
  
  RESULTS
  After aortic valve operations, no hospital deaths occurred, and troponin T levels (median 0.19 ng · mL(-1) for del Nido vs 0.21 ng · mL(-1) for Buckberg) were similar, with no statistically significant change in left ventricular ejection fraction (P = .4). Aortic clamp, bypass, and operating room times were shorter with del Nido solution (44 ± 14 vs 56 ± 19; 56 ± 18 vs 70 ± 24; and 285 ± 44 vs 308 ± 61 minutes, respectively; P < .0001). Peak intraoperative glucose levels (170 ± 31 vs 240 ± 41 mg · dL(-1); P < .0001) and postoperative insulin-drip requirements (46% vs 82%; P < .0001) were lower. After mitral operations, there were no hospital deaths and no statistically significant cardioplegia-specific changes in troponin T levels (median 0.37 ng · mL(-1) for del Nido vs 0.4 ng · mL(-1) for Buckberg) or postoperative left ventricular ejection fraction (P = .13). We found no clear time differences with del Nido solution in mitral cases, but intraoperative glucose levels and postoperative insulin-drip requirements (184 ± 37 vs 250 ± 60 mg · dL(-1) and 50% vs 67% mg · dL(-1), respectively; P = .009) were lower.
  
  
  CONCLUSIONS
  del Nido solution can be used safely and effectively as an alternative to Buckberg solution in adult isolated valve surgery and is associated with lower insulin requirements and potential time and cost savings.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: micks@ccf.org.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Mick
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Robich
authors.affiliation: Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Penny L
authors.initials: PL
authors.lastname: Houghtaling
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Soltesz
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Johnston
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D002314:Cardioplegic Solutions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D057216:Propensity Score; D016896:Treatment Outcome
chemical_list: D002314:Cardioplegic Solutions