Del Nido Cardioplegia in Coronary Artery Bypass Grafting Surgery: A safe, efficacious and economic alternative to St. Thomas solution; an experience from a developing nation

Perfusion ◽  
2021 ◽  
pp. 026765912199103
Author(s):  
Purna Bahadur Moktan Lama ◽  
Prabhat Khakural ◽  
Shailendra Sigdel ◽  
Mahendra Raj Bhatta ◽  
Rabindra Sah Teli ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Aortic Cross Clamp Time ◽  
Artery Bypass Grafting ◽  
National Recommendation ◽  
Economical Alternative

Introduction: del Nido cardioplegia is a newer solution getting popular worldwide, whereas in Nepal, St. Thomas cardioplegia solution is conventionally used. There is no national recommendation on cardioplegia solutions supported by evidences from Nepalese studies. This study aimed to evaluate and compare the efficacy of these solutions in Nepalese patients undergoing coronary artery bypass grafting. Methods: Patients undergoing coronary revascularization, from May 2018 to December 2019, were randomized into St. Thomas and del Nido groups based on the cardioplegia administered, with 45 patients in each group. Preoperative, intraoperative, and postoperative parameters and cost of cardioplegia preparation in the two groups were compared. Results: The cardiopulmonary bypass time (106.13 ± 24.65 minutes vs 107.62 ± 18.69 minutes, p = 0.02), aortic cross clamp time (66.22 ± 15.40 minutes vs 72.07 ± 12.23 minutes, p = 0.04), volume (1059.22 ± 100.30 ml vs 1526.67 ± 271.81 ml, p < 0.001) and number of cardioplegia doses (1.00 ± 0.00 vs 2.51 ± 0.66, p < 0.001) were significantly lower with del Nido cardioplegia. A lower CPK-MB at second post-operative (59.91 ± 31.62 vs 73.82 ± 37.25, p = 0.03) and a higher left ventricle ejection fraction at discharge (56.33 ± 8.94% vs 50.45 ± 8.55%, p < 0.001) was observed in del Nido group. There was one death in St. Thomas group. ICU and hospital stay were similar in both groups. St. Thomas solution was found to be costlier than del Nido solution (USD 5.40 ± 0.96 vs USD 3.50 ± 0.34, p < 0.001). Conclusion: The del Nido cardioplegia was found to be efficacious, safe and more economical alternative to St. Thomas solution.

State of the Art Surgical Coronary Revascularization

2021 ◽  
Keyword(s):  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Ischaemic Heart Disease ◽  
Coronary Artery Bypass ◽  
State Of The Art ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

State of the Art Surgical Coronary Revascularization is an authoritative textbook dedicated to the art and science of surgical coronary revascularization, with 71 chapters, organized in nine sections, and written by over 100 recognized world experts. The textbook covers every aspect of the surgical management of coronary artery pathology and ischaemic heart disease. It provides extensive sections detailing pathophysiology, evaluation, and medical and percutaneous management of ischaemic heart disease as well as general outcomes and quality assessment for coronary artery bypass grafting. Pre-, intra- and postoperative management of coronary artery bypass graft patients is emphasized in detail as are the core surgical principles in the conduct of coronary artery bypass grafting, with special focus on the selection of conduits and how to optimize the performance of both on- and off-pump surgery to reduce morbidity and mortality. There are detailed sections on how to improve outcomes with both arterial and venous bypass grafts.

Precision Incision Robotic Coronary Revascularization via 3.9-cm Minithoracotomy

2012 ◽  
Vol 7 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Francis P Sutter ◽  
Tami Berry ◽  
MaryAnn C Wertan
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Heart Surgery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Complication Rates ◽  
Bypass Grafting ◽  
Robotic Assisted ◽  
Artery Bypass Grafting

Coronary artery bypass grafting remains the treatment choice for coronary artery disease; but sternotomy, the most commonly used approach, compromises its benefits with postoperative morbidity, higher complication rates, and prolonged length of hospital stay. Despite this, minimally invasive and robotic-assisted technology has not been adopted or widely embraced because supporting literature on robotic-assisted coronary artery bypass grafting is extremely limited. Since 2005, the cardiothoracic surgical team at our institution has been developing and maturing an effective method using robotic harvesting of the left internal mammary artery (LIMA) and beating heart surgery through a minithoracotomy for coronary revascularization. This surgical technique involves precisely placing the robotic endoscopic port immediately over the left anterior descending (LAD) artery target site. The robotically harvested LIMA is secured to the epicardium at the LAD target, the robotic instruments are removed, and the endoscopic port site is enlarged slightly greater than 1 cm to become the minithoracotomy and allow for LIMA-to-LAD anastomosis. The other two robotic ports are used to complete the procedure without a need for additional incisions. This standardized method has been used in more than 750 patients, and since 2009, the last 377 consecutive non-rib-spreading minithoracotomy incisions measured a median of 3.9 cm (mean [SD], 4.16 [1.2748] cm; range, 2.3–12.0 cm). This “How I Do It” article describes our methods in detail and associated robotic nuances.

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