We analyzed all isolated miavr replacements from 520. The del nido cardioplegia solution has been in use for 18 years at boston childrens hospital. May 22, 2012 cardioplegia is an integral and essential method of myocardial protection for patients of all ages requiring cardiac surgery in which the heart must be stopped. What presented a challenging proposition was the surgeons proclivity to perfuse the svg after each distal, establish graft patency and q rates, do the valve replacement after completing the distals. Ota t, yerebakan h, neely rc, mongero l, george i, et al. This study seeks to determine if multidose del nido cardioplegia offers additional benefits over singledose del nido cardioplegia.
P del nido cardioplegic solution has the potential to provide superior myocardial protection in senescent hearts by preventing electromechanical activity during cardioplegic arrest and ca2. Aerobic metabolism is not usually possible for the entire myocardial arrest period. Oblenes, md,a,b,c camille hancock friesen, md,a,b,d ahmad ali,c and susan howlett, phde,f objective. Exclusive use of del nido cardioplegia administration in all adult patients undergoing cardiac surgery has been studied for operative, postoperative and myocardial protection outcomes. The developmental history and use of del nido cardioplegia was recently described in the september 2012, volume 44, number 3 guest editorial of ject. This may improve the surgical flow and the patient outcomes.
Del nido cardioplegia was replenished less often than cb cardioplegia. Commonly referred to as del nido solution, this blood and crystalloid mixed formula 1. Utilization of del nido cardioplegia in adult coronary artery. Aged hearts are particularly vulnerable to reperfusion injury. There was a more pronounced resting membrane potential depolarization with del nido cardioplegia than with standard cardioplegia 36. We analyzed the impact and safety of del nido cardioplegia dnc in patients undergoing minimally invasive aortic valve replacement miavr. We evaluated the relationship between the cardioplegic solution, the fluctuation of sodium. Pdf history and use of del nido cardioplegia solution at boston. The medtronic myotherm xp cardioplegia delivery system was specifically designed to effectively handle air, in a lowprime design, while providing fast responses through efficient heat transfer. Looking for protocols the potential benefits of del nido.
We evaluated the efficacy of cardiac protection and clinical outcomes of dc vs blood cardioplegia bc in adult coronary artery bypass graft cabg patients. Inasmuch as immature cardiomyocytes have similar properties, a specialized cardioplegic solution del nido cardioplegia designed to protect childrens hearts may also be beneficial for elderly patients. Pdf aged hearts are particularly vulnerable to ischemiareperfusion injury. The potential benefits of del nido cardioplegia jtcvs. Del nido cardioplegia has the potential to provide superior. However, blood proteins and the other components have several potential benefits which include buffering from proteins. Article information, pdf download for del nido cardioplegia in adult. Request pdf protecting the aged heart during cardiac surgery. Pdf cardioplegia is an integral and essential method of myocardial protection. Fluctuations in the sodium concentration during cardiopulmonary bypass cpb can adversely affect the central nervous system.
The del nido cardioplegia solution has been used extensively in congenital heart surgery for more than 20 years and more recently for adults. Most commonly, however, the word cardioplegia refers to the solution used to bring about asystole of the heart, or heart. With this advantage and single dose property, the dn formula has been widely used during pediatric. The potential benefits of del nido cardioplegia by stacy b. In the dn cardioplegia group, 99 patients 8% required intraoperative iabp counterpulsation in comparison with 61 patients 7% in the other group. Del nido cardioplegia as a safe and effective method of. Oblenes, camille hancock friesen, ahmad ali and susan howlett download pdf 273 kb. New insights on the use of del nido cardioplegia in the adult cardiac. Although the advantage of this strategy is its simplicity and the rapid onset of. Del nido cardioplegia requires less frequent dosing and has potential benefits in adult cardiac surgery and minimally invasive valve surgery which include decreased workflow interruptions, shorter aortic crossclamp and bypass times and has better myocardial protection. Del nido cardioplegia, adult cardioplegia, myocardial protection, blood. The potential benefits of del nido cardioplegia aged hearts are more vulnerable than mature hearts to reperfusion injury during. The use of dn was then expanded to adult cardiac surgery based on the notion that susceptibility to ischaemicreperfusion injury between neonatal and elderly myocardium would be similar. We were planning on using del nido cardioplegia to arrest the heart, and reap the benefits of 90 minute dosing intervals during the procedure.
Del nido cardioplegic solution has the potential to provide superior myocardial protection in senescent hearts by preventing electromechanical activity during. A single dose of del nido cardioplegia contains 26 meql of potassium chloride, ml of 1% lidocaine, 3. Del nido cardioplegia, extensively used in pediatric cardiac surgery, provides a bloodless quiescent operative field for a longer period than other cardioplegia solutions 4, 5. Thirtyfour pediatric patients with aortic cross clamp times greater than 90 minutes were grouped by modified adult ma multidose solution or del nido dn single dose solution. Del nido cardioplegia can be safely administered in highrisk. Table 2 components of crystalloid solution used in the del nido and blood cardioplegia variables del nido blood cardioplegia components base plasmalyte a, 1 l 5% dextrose, 1 l nacl meq 0 77 kcl meq 26 30 nahco 3 meq 20 20% mannitol ml 16 50 10% mgso 4 ml 20 0 1% lidocaine ml 0 cardioplegia.
When used with hypothermia and ischemia, the action may be characterized as cold ischemic potassium. Transitioning to del nido cardioplegia for allcomers. Inclusion criteria included adult patients aged 19 to 79 years. Cardioplegia plays a critical role keeping the heart protected and arrested during cardiopulmonary bypass by maintaining a desired ratio of blood. Oct 30, 2014 del nido dn cardioplegia solution provides a depolarized hyperkalemic arrest lasting up to 60 minutes, and the addition of lidocaine may limit intracellular calcium influx. Dn solution contains various additives including magnesium and lidocaine, which inhibit calcium accumulation in myocytes and prevent ischemiareperfusion injury after cardiac surgery. Del nido cardioplegia has the potential to provide superior myocardial protection for elderly patients undergoing cardiac surgery.
Purported benefits of blood over crystalloid cardioplegia are. Aged hearts are more vulnerable than mature hearts to reperfusion injury during cardiac surgery. Elderly patients undergoing cardiac surgery have a higher risk of significant cardiac dysfunction and reduced survival than do younger adult patients. Singledose dn cardioplegia solution may offer an alternative myocardial protection strategy to multidose cold whole blood wb cardioplegia following acute myocardial infarction ami. Fallouh cardiac surgical researchcardiothoracic surgery, the rayne institute kings college london, guys and st thomas nhs foundation trust, st thomas hospital, london se1 7eh, uk article info. The del nido cardioplegia solution has been in use for 18 years at boston. To achieve this, single brief cold cardioplegia infusions during 6090 min or longer aortic clamping durations were described by bretschneider et al. Del nido dn cardioplegia was formulated to act as singledose administration in pediatric patients. P cardioplegia, and contractions could not be induced by field stimulation of cardiomyocytes arrested with del nido cardioplegia 011 vs 911 cells. Median postoperative creatine kinase mb isotype did not differ between del nido cardioplegia solution and blood cardioplegia solution 48.
Del nido cardioplegia dc 3 has demonstrated a long safety. History and use of del nido cardioplegia solution at boston. History and use of del nido cardioplegia solution at boston childrens. This singledose approach avoids retrograde delivery strategies and varying warm and cold cardioplegia infusion temperatures. Technically, this means arresting or stopping the heart so that surgical procedures can be done in a still and bloodless field. Govindapillai a, hua r, rose r, friesen ch, oblenes sb. Numerous cardioplegia solutions and delivery methods have been developed. A single dose of cardioplegia was more common in the dn group than in the cb group p 0. Del nido cardioplegia, adult cardioplegia, myocardial protection. Jun 21, 2019 cardioplegic solution with added sodium bicarbonate when cooled and instilled into the coronary artery vasculature, causes prompt arrest of cardiac electromechanical activity, combats intracellular ion losses and buffers ischemic acidosis. Propensity matched analysis of del nido cardioplegia in adult. History and use of del nido cardioplegia solution at boston childrens hospital. Delivery of del nido solution will be administered in a 1.
Mar 24, 2016 del nido cardioplegia dc offers prolonged cardiac protection with singledose administration and has had a long safety record in pediatric cardiac surgery. Del nido dn cardioplegia has been developed to protect vulnerable immature cardiomyocytes. Pdf protecting the aged heart during cardiac surgery. Using a propensity score, dn group was compared to 251 patients having received intermittent cold blood. From november 2016 to october 2017, del nido cardioplegia was used in 1 consecutive patients dn group. Del nido cardioplegia randomized trial full text view.
Despite potential benefits of histidinetryptophanketoglutarate htk solution as a cardioplegic solution, it can cause hyponatremia, especially in pediatric patients. Cardioplegia delivery system overview myotherm xp medtronic. The single dose cardioplegia technique for myocardial protection during congenital heart surgery is a viable alternative to multidose protocols. This singledose approach avoids retrograde delivery strategies and. Use of del nido cardioplegia for adult cardiac surgery at the. Cardioplegia is an integral and essential method of myocardial protection for patients of all ages requiring cardiac surgery in which the heart must be stopped. Pharmacological arrest and cardioprotection during global ischemia and reperfusion david j. Pdf del nido cardioplegia can be safely administered in. Since i very rarely use retrograde cardioplegia and have gone to a one shot modified del nido solution 4 parts blood. It may be helpful to note that del nido cardioplegia can therefore be classified as a modified depolarizing agent, primarily as a result of the properties of lidocaine and magnesium.
Single dose myocardial protection technique utilizing del. This randomized controlled trial examined whether expanding this technique to adult cardiac surgery confers benefits in surgical workflow and clinical outcome compared with bloodbased cardioplegia. The word cardioplegia combines the greek cardio meaning the heart, and plegia paralysis. Del nido cardioplegia for minimally invasive aortic valve. The potential benefits of del nido cardioplegia oblenes sb, friesen ch, ali a, howlett s jtcs 2010 find me an adult publication using del nido literature search objective. However, its application in the adult population has thus far been limited.
Aerobic metabolism is not usually possible for the entire. Al garni1,4 1prince sultan military cardiac centre, riyadh 11564, saudi arabia. The use of del nido cardioplegia in adult cardiac surgery. The potential benefits of del nido cardioplegia article in the journal of thoracic and cardiovascular surgery 14. The more recently introduced del nido cardioplegic solution 7,8 has. In the last decade, del nido cardioplegia was gradually integrated into adult cardiac surgery surgical. Use of del nido cardioplegia provides superior functional recovery in isolated hearts. We recently showed that singledose del nido cardioplegia was superior to standard multidose 4. Use of del nido cardioplegia solution and a lowprime.
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