title: del Nido cardioplegia in adult cardiac surgery - scopes and concerns.
abstract: The convenience offered by a single-dose cardioplegia strategy is the avoidance of interruption of the flow of surgery and, more importantly, a significant reduction in the cross-clamp time. del Nido cardioplegia is an extracellular cardioplegic solution which serves these purposes and has been used successfully in pediatric cardiac surgery. The subsequent extrapolation of its use in adult cardiac surgery has returned encouraging results, as evidenced by recent literature. The use of del Nido cardioplegia in adults has been reported to shorten the cross-clamp time, cardiopulmonary bypass time and overall operating time. Intraoperative peak glucose value and insulin requirement have also been reported to be lower with del Nido cardioplegia, which can have prognostic significance. There have been reports of lesser incidence of atrial fibrillation and the number of defibrillations required with use of this technique. However, some unique concerns still remain. The lack of prospective randomized trials, the trend of elevation in CKMB (as reported by one study) and the need for a protocol-based approach to its use in adults are to be given due consideration while adopting its use in adults. This review attempts to have an overview on del Nido cardioplegia, its advantages, the recent studies comparing it with conventional cardioplegia techniques and the potential areas of concern with its use in adult cardiac surgery.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Rajagiri Hospital, Aluva, Kochi, Kerala, India.
authors.forename: George Jose
authors.initials: GJ
authors.lastname: Valooran
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Rajagiri Hospital, Aluva, Kochi, Kerala, India shivnairmd@gmail.com.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Nair
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Rajagiri Hospital, Aluva, Kochi, Kerala, India.
authors.forename: Krishnan
authors.initials: K
authors.lastname: Chandrasekharan
authors.affiliation: Perfusion, Department of Cardiovascular and Thoracic Surgery, Rajagiri Hospital, Aluva, Kochi, Kerala, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Simon
authors.affiliation: Perfusion, Department of Cardiovascular and Thoracic Surgery, Rajagiri Hospital, Aluva, Kochi, Kerala, India.
authors.forename: Cyril
authors.initials: C
authors.lastname: Dominic
mesh_terms: D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass / Q000379:methods* / Q000639:trends; D002648:Child; D002675:Child, Preschool; D006324:Heart Arrest, Induced / Q000379:methods* / Q000639:trends; D006801:Humans
keywords: adult cardiac surgery; cardioplegia; del Nido; diastolic arrest; myocardial protection