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Del Nido Cardioplegia in Ascending Aortic Surgery
Seminars in Thoracic and Cardiovascular Surgery  (IF2.006),  Pub Date : 2021-10-28, DOI: 10.1053/j.semtcvs.2021.10.008
Holliann Willekes, Jessica Parker, Justin Fanning, Stephane Leung, David Spurlock, Edward Murphy, Theodore Boeve, Marzia Leacche, Charles Willekes, Tomasz Timek

Del Nido cardioplegia offers equivalent myocardial protection and clinical outcomes to blood cardioplegia in adult isolated CABG and valve patients, but the safety and efficacy of del Nido in complex cases with prolonged aortic cross-clamp times is still unknown. 443 patients at our center underwent replacement of the ascending aorta using either del Nido (n=182) or blood (n=261) cardioplegia. Two surgeons used del Nido exclusively and six used blood exclusively over the study period. Propensity matching of pre-operative characteristics yielded 172 well matched pairs. Emergency and re-operative cases were included. Clinical data were extracted from our local database. Troponin levels were drawn at 12 hours post-op in all patients. Rates of peri-operative mortality (4.7% vs. 5.2%), stroke (5.8% vs. 7.0%), renal failure (11.6% vs. 12.2%), atrial fibrillation (36.0% vs. 31.4%), intra-aortic balloon pump insertion (2.3% vs.1.2%), and extra corporeal membrane oxygenation use (4.7% versus 4.1%) did not differ between blood and del Nido groups. Post-op Troponin T levels were 0.50[0.35, 0.86] ng/ml and 0.40[0.20, 0.70] ng/ml for blood and del Nido, respectively (p<0.0001). Post-op echocardiography was available in 333/344 (96.8%) patients, and there was no difference in change in EF from pre- to post-op between blood 0.0[-6.0, 5.0]% and del Nido 0.0 [-6.0, 3.5]% (p=0.201). Subgroup analysis of patients with aortic cross-clamp time greater than 180 minutes (blood=77, del Nido=27) revealed no difference in troponins, ejection fraction, or clinical outcomes. Five-year survival was 85.9[76.8, 91.7] % and 79.8[71.2, 86.1] % for blood and del Nido, respectively (p=0.151). In ascending aortic surgery with prolonged operative times, no differences were observed in myocardial protection or clinical outcomes with the use of del Nido cardioplegia compared to blood cardioplegia.