title: Short-term outcomes in adult cardiac surgery in the use of del Nido cardioplegia solution.
abstract: OBJECTIVE
  Del Nido cardioplegia in adult cardiac surgery has not been studied although it has been in common use as a "single" dose cardioplegia in pediatric heart surgery. We retrospectively assessed the short-term (in-hospital) clinical outcomes of patients undergoing aortic valve replacement (AVR) using del Nido cardioplegia solution, comparing it to conventional multi-dose whole blood cardioplegia.
  
  
  METHODS
  We switched our cardioplegia protocol from conventional whole blood cardioplegia exclusively to del Nido solution in May 2011. In 2011, 240 consecutive patients underwent isolated AVR. One hundred and seventy-eight of them were operated on with the use of del Nido cardioplegia (del Nido group) and whole blood cardioplegia (conventional group) was used in the other 62 patients. Isolated AVR was chosen as a cohort because of its relative simplicity and the similarity of surgical techniques among surgeons. Propensity-score matching identified 54 matched pairs for analysis.
  
  
  RESULTS
  The retrograde cardioplegia technique was used in 19 cases (35.2%) in the del Nido group and 52 cases (96.3%) in the conventional group (p<0.001). Mean cardiopulmonary bypass time and mean aortic cross-clamp time were significantly shorter in the del Nido group compared to the conventional group: 71 ± 16 min vs. 84 ± 28 min (p<0.01), 52 ± 14 min vs. 60 ± 16 min (p<0.01), respectively. Postoperative inotropic support was required in 11 patients (20.4 %) in the del Nido group and 13 patients (24.1 %) in the conventional group (p=0.82) with no statistical difference. No patient required a postoperative intra-aortic balloon pump and in-hospital mortality was 0% in both groups. There was no significant difference in postoperative complications between the two groups.
  
  
  CONCLUSIONS
  Short-term outcomes in adult cardiac surgery using del Nido solution were acceptable and comparable to conventional multi-dose whole blood cardioplegia. The del Nido cardioplegia technique was associated with shortened cross-clamp times and less frequent utilization of the retrograde cardioplegia delivery technique.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA Department of Surgery, Section of Cardiac & Thoracic Surgery, The University of Chicago, Chicago, IL, USA tota@surgery.bsd.uchicago.edu.
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Ota
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA.
authors.forename: Halit
authors.initials: H
authors.lastname: Yerebakan
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Neely
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Mongero
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA Departments of Medicine and Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Williams
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA.
authors.forename: Emile
authors.initials: E
authors.lastname: Bacha
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA Department of Cardiothoracic Surgery, The Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D002314:Cardioplegic Solutions / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D002314:Cardioplegic Solutions
keywords: adult; cardiac surgery; clinical outcome; del Nido cardioplegia; myocardial protection