title: Propensity Matched Analysis of del Nido Cardioplegia in Adult Coronary Artery Bypass Grafting: Initial Experience With 100 Consecutive Patients.
abstract: BACKGROUND
  Del Nido cardioplegia (DC) offers prolonged cardiac protection with single-dose administration and has had a long safety record in pediatric cardiac surgery. However, its application in the adult population has thus far been limited. We evaluated the efficacy of cardiac protection and clinical outcomes of DC vs blood cardioplegia (BC) in adult coronary artery bypass graft (CABG) patients.
  
  
  METHODS
  Clinical outcomes of 100 consecutive isolated CABG patients who received DC (May to September 2014) were compared with the previous 100 consecutive isolated CABG patients receiving BC (December 2013 to April 2014). Propensity matching yielded 82 pairs. The same surgeons operated on all patients. Clinical patient characteristics and data were extracted from our local The Society of Thoracic Surgeons database and the electronic medical record.
  
  
  RESULTS
  Preoperative characteristics were similar between BC and DC patients before and after propensity matching. BC patients received anterograde and retrograde cardioplegia, whereas DC was delivered anterograde, with 92 of 100 patients receiving a single dose only. Inotropic support upon arrival to the recovery unit did not differ between BC and DC (0.28 ± 0.11 vs 0.27 ± 0.11 μg/kg/min milrinone [p = 0.8] and 0.05 ± 0.03 vs 0.05 ± 0.03 μg/kg/min norepinephrine [p = 0.7]), nor did postoperative troponin T levels (0.56 ± 0.48 vs 0.70 ± 1.27 ng/mL; p = 0.3). The peak intraoperative glucose level was higher in BC (209.8 ± 40.4 mg/dL) than in DC (161.4 ± 42.3 mg/dL) patients (p < 0.001). No patients died in either group, and the postoperative incidence of atrial fibrillation, stroke, reoperation for bleeding, and prolonged intubation did not differ between the groups before and after matching. There was also no difference in the postoperative ejection fraction between the groups (0.51 ± 0.13 vs 0.47 ± 0.13 for BC and DC, respectively; p = 0.17).
  
  
  CONCLUSIONS
  In our initial experience, DC provided equivalent myocardial protection and clinical outcomes to BC in adult isolated CABG patients. DC was associated with lower cardiopulmonary bypass glucose levels than BC and demonstrated the feasibility of single-dose administration for routine coronary operations.
authors.affiliation: Division of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan. Electronic address: tomasz.timek@specctrumhealth.org.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Timek
authors.affiliation: Division of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
authors.forename: Charles
authors.initials: C
authors.lastname: Willekes
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, Michigan.
authors.forename: Olivia
authors.initials: O
authors.lastname: Hulme
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, Michigan.
authors.forename: Ben
authors.initials: B
authors.lastname: Himelhoch
authors.affiliation: Anesthesia Practice Consultants, Grand Rapids, Michigan.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nadeau
authors.affiliation: DeVos Cardiovascular Research Program, and Van Andel Institute/Spectrum Health, Grand Rapids, Michigan.
authors.forename: Andrew
authors.initials: A
authors.lastname: Borgman
authors.affiliation: Division of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
authors.forename: Jeff
authors.initials: J
authors.lastname: Clousing
authors.affiliation: Division of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
authors.forename: Dick
authors.initials: D
authors.lastname: Kanten
authors.affiliation: Division of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
authors.forename: Joe
authors.initials: J
authors.lastname: Wagner
mesh_terms: D000328:Adult; D002314:Cardioplegic Solutions / Q000494:pharmacology*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control; D061646:Operative Time; D061214:Patient Safety; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D057216:Propensity Score; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002314:Cardioplegic Solutions