Comparison of Del Nido Cardioplegia with Blood Cardioplegia in Adult Combined Surgery

2017 ◽  
Vol 12 (5) ◽  
pp. 356-362 ◽  
Author(s):  
Raphael Hamad ◽  
Anthony Nguyen ◽  
Éric Laliberté ◽  
Denis Bouchard ◽  
Yoan Lamarche ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Myocardial Protection ◽  
Troponin T ◽  
Hospital Death ◽  
Vasoactive Agent ◽  
Blood Cardioplegia ◽  
Creatine Kinase Mb

Objective del Nido solution (DNS) is a single-dose cardioplegia designed for pediatric use proposed to offer superior myocardial protection in adults. However, few data support this claim. We hypothesized that DNS and modified blood cardioplegia solution (BS) provide equivalent safety in combined adult valve surgery. Methods Between November 2014 and December 2015, 25 patients underwent primary aortic valve replacement and concomitant coronary artery bypass grafting (CABG) with DNS. Outcomes were compared with 25 patients who underwent the same surgery with BS between September 2013 and August 2015. Results All preoperative characteristics, comorbidities, and number of CABG performed were similar between groups. One hospital death occurred in the BS group. Postoperative creatine kinase, MB isotype (16.7 ± 5.3 μg/L vs. 22.1 ± 8.9 μg/L, P = 0.011) and troponin T levels (260 ± 105.3 ng/L vs. 370.5 ±218.4 ng/L, P =0.028) were significantly lower in the DNS group. There was no difference in inotropic or vasoactive agent use ( P = 0.512). Cardiopulmonary bypass times (65.5 ± 12.5 min vs. 76.6 ± 19.1 min, P = 0.019) and cross-clamp times (55.6 ± 11.2 min vs. 64.3 ± 18.9 min, P = 0.05) were lower in the DNS group but total operating room times ( P = 0.198) were similar. Peak postoperative creatinine levels were similar in both groups ( P = 0.063). There was no difference in postoperative outcomes including acute renal failure ( P > 0.999), atrial fibrillation ( P = 0.773), acute respiratory failure ( P > 0.999), nor stroke or transient ischemic attack ( P > 0.999). Intensive care unit stay ( P = 0.213) and hospital stay ( P = 0.1) did not differ between groups. Conclusions The DNS can be used as an alternative to BS in adult concomitant aortic valve replacement + CABG surgery. This supports our hypothesis that in this specific setting, DNS provides comparable myocardial protection as BS, with possibly shorter cardiopulmonary bypass and cross-clamp times.

scholarly journals Cerebral microemboli in mini-sternotomy compared to mini- thoracotomy for aortic valve replacement: a cross sectional cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Marija Bozhinovska ◽  
Matej Jenko ◽  
Gordana Taleska Stupica ◽  
Tomislav Klokočovnik ◽  
Juš Kšela ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Techniques ◽  
Aortic Valve Area ◽  
Link Type ◽  
Microembolic Signal ◽  
Mini Thoracotomy ◽  
Addenbrooke’S Cognitive Examination

Abstract Background Recently adopted mini-thoracotomy approach for surgical aortic valve replacement has shown benefits such as reduced pain and shorter recovery, compared to more conventional mini-sternotomy access. However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation. Methods Trans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke’s Cognitive Examination Revised Test before and 30 days after surgical procedure. Results A total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8 ± 14.4 vs.72 ± 5.84, p = 0.003), heavier (85.2 ± 12.4 vs.72.5 ± 12.9, p = 0.002) and had higher body surface area (1.98 ± 0.167 vs. 1.83 ± 0.178, p = 0.006). Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158 ± 24 vs. 134 ± 30 min, p < 0.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677–10.60, p = 0.027). Addenbrooke’s Cognitive Examination Revised Test score decreased equivalently in both groups (p = 0.630) (MS: 85.2 ± 9.6 vs. 82.9 ± 11.4, p = 0.012; MT: 85.2 ± 9.6 vs. 81.3 ± 8.8, p = 0.001). Conclusion There is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline. Trial registry number clinicaltrials.gov, NCT02697786 14.

The impact of del Nido cardioplegia solution on blood morphology parameters

Perfusion ◽  
2021 ◽  
pp. 026765912110490
Author(s):  
Krzysztof Sanetra ◽  
Wojciech Domaradzki ◽  
Marek Cisowski ◽  
Rajesh Shrestha ◽  
Krzysztof Białek ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Blood Cell ◽  
Valve Replacement ◽  
Transfusion Rate ◽  
Blood Cardioplegia ◽  
Blood Morphology ◽  
Cold Blood ◽  
Cold Blood Cardioplegia ◽  
Morphology Parameters

Background: Crystalloid cardioplegic solutions are believed to reduce hemoglobin significantly and increase the transfusion rate. However, recent reports indicate that the del Nido cardioplegia may preserve blood morphology parameters. Methods: In “The del Nido versus cold blood cardioplegia in aortic valve Replacement” trial patients undergoing aortic valve replacement were randomized into the del Nido (DN) or cold blood cardioplegia (CB) group. For the subanalysis, patients who underwent blood transfusions were excluded from the study. Red blood cell (RBC) count, hemoglobin, white blood cell (WBC) count and platelet (PLT) count were measured before the surgery, 24-, 48-, and 96 hours postoperatively. Furthermore, percental variation in first-last measure was compared in groups. In addition, indexed normalized ratio (INR) and activated partial thromboplastin time (aPTT) were compared preoperatively and 24 hours after the surgery. Results: Eighteen (24%) patients from the del Nido group and 22 (29.3%) patients from the CB group received blood product transfusions (p = 0.560) and were excluded from further analysis. As such, 57 patients remained in DN group and 53 patients remained in CB group. No difference was found in RBC, hemoglobin, WBC, and platelet count in time intervals. Percental variation in first-last measure revealed higher fall in RBC (p = 0.0024) and hemoglobin (p = 0.0028) in the CB group. No difference was shown in preoperative and 24-hour postoperative INR and aPTT. Conclusions: The del Nido cardioplegia does not decrease blood morphology parameters when compared to cold blood cardioplegia and may be used alternatively regardless of bleeding and coagulopathy risk.

Abstract 19134: Elevated Troponin T is Associated with Adverse Outcomes After Aortic Valve Replacement

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ashwat Dhillon ◽  
Kanhaiya Poddar ◽  
Murat Tuzcu ◽  
Eric Roselli ◽  
Lars Svensson ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Troponin T ◽  
Coronary Revascularization ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Post Procedure

Background: Data regarding association of elevated cardiac enzymes and adverse outcomes in patients who undergo aortic valve replacement (AVR) has been inconclusive. Role of coronary revascularization prior to AVR remains uncertain. We sought to understand prognostic implication of post procedure troponin T (TnT) elevation in patients undergoing AVR. Hypothesis: We hypothesized that patients with significantly elevated TnT after AVR will have worse outcomes representing important coronary circulation which is not revascularized. Methods: We retrospectively studied 4648 consecutive patients who underwent AVR at a single tertiary care center between January 2007 and December 2013. These were divided into surgical AVR (SAVR) and transcatheter AVR (TAVR). Median post procedure peak TnT was identified in the SAVR and TAVR groups. Patients were divided into quartiles based on median TnT level. Results: Of 4648 patients who underwent AVR, 4200 (66% male) were SAVR and 448 (59% male) were TAVR. Median post procedure peak TnT values in the TAVR and SAVR group were 0.19 [0.08-0.39] & 0.36 [0.22-0.64] respectively (p<0.001). 6 month mortality was 1.5% (65/4200) in SAVR cases and 2.7% (12/448) in TAVR cases (p=0.08). In patients with TnT less than 50 th percentile, 6 month mortality was 0.7% & 1.8% after SAVR & TAVR respectively (p=0.1). In patients with TnT higher than 50 th percentile, 6 month mortality was 2.4% & 3.6% after SAVR & TAVR respectively (p=0.26). In the SAVR group, mortality was 0.7% in patients with TnT levels less than 50 th percentile & 2.4% in patients with TnT higher than 50 th percentile (p<0.001). See Figure. Conclusion: Peak troponin T was significantly higher after SAVR as compared to TAVR. Higher post procedure peak TnT is associated with increased 6 month mortality. These results are highly significant in the SAVR group. The mechanism and significance of these findings requires further studies.

Abstract 13322: In-hospital Death and Stroke Following Surgical Aortic Valve Replacement: a Nationwide Perspective

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shikhar Agarwal ◽  
Aatish Garg ◽  
Akhil Parashar ◽  
E M Tuzcu ◽  
Samir R Kapadia
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Low Risk ◽  
National Database ◽  
Hospital Death ◽  
Significant Heterogeneity ◽  
Surgical Risk ◽  
Neurological Event

Significant heterogeneity exists in the current literature around the actual incidence of stroke following aortic valve replacement (AVR) among high-risk patients. We aimed to evaluate the risk of stroke in patients undergoing surgical AVR from a large national database. Methods: We used the 2002-2011 Nationwide Inpatient Sample for this analysis. All patients undergoing isolated AVR or AVR with coronary artery bypass grafting (AVR+CABG) were identified using ICD codes. In-hospital death and any adverse neurological event were co-primary outcomes. Based on predicted death estimates, the study population was classified into low (<8%) and high (≤8%) surgical risk Results: Incidence of in-hospital death was 3.0% and 5.1% among patients undergoing isolated AVR and AVR+CABG respectively. The incidence of adverse neurological event was 2.0% and 2.9% among patients undergoing AVR and AVR+CABG respectively. We demonstrated a progressive increase in the risk of in-hospital death and adverse neurological events with increasing age (Fig 1). The incidence of in-hospital death was as high as 5.7% and 7.4% among patients aged ≤ 85 years undergoing isolated AVR and AVR+CABG respectively. Similarly, the incidence of any adverse neurologic event was 3.2% and 3.6% among patients aged ≤ 85 years undergoing isolated AVR and AVR+CABG respectively. We demonstrated a significantly higher risk of adverse neurological events among the high-risk cohort as compared to the low-risk cohort. Among patients undergoing isolated AVR, the incidence of any adverse neurological event was 1.8% and 4.8% in the low-risk and the high-risk cohorts respectively. Similarly, among patients undergoing AVR+CABG, the incidence of any adverse neurological event was 2.7% and 5.4% in the low-risk and the high-risk cohorts respectively. Conclusions: The incidence of in-hospital death and adverse neurological events was significantly higher among patients with advanced age and elevated surgical risk.

scholarly journals Myocardial protection during aortic valve replacement

1981 ◽  
Vol 82 (6) ◽  
pp. 837-847 ◽  
Author(s):  
Christian L. Olin ◽  
Vollmer Bomfim ◽  
Rutger Bendz ◽  
Lennart Kaijser ◽  
Stellan J. Strom ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Myocardial Protection
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