Impact of Modified Del Nido Versus Traditional Cold Cardioplegia on Myocardial Protection in Cardiac Patients with a Low Ejection Fraction

Ashraf Mostafa; Kerellos Max; Pierre Tawadros

Ashraf Mostafa Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
Kerellos Max Department of Cardiothoracic Surgery, Fayoum University Hospital, Fayoum, Egypt https://orcid.org/0000-0002-3741-7382
Pierre Tawadros Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Egypt

Keywords: Cardiac surgery, Cardioplegia, Modified Del Nido, Myocardial preservation

Abstract

Background: The optimal cardioplegia solution in patients undergoing complex cardiac surgery is debatable. This study aimed to compare the efficacy of modified Del Nido cardioplegia to that of conventional cold cardioplegia in patients undergoing cardiac surgery with low ejection fraction.

Methods: Participants were randomly divided into two groups: Group I had modified Del Nido cardioplegia (n=23), while Group II had standard blood cardioplegia (n=23).

Results: There was no difference in baseline data between the study groups. Group I had 20% lower additional doses of Del Nido (p= 0.032) and had shorter periods of cardiopulmonary bypass (2.78 ± 0.69 vs 3.35 ± 0.72 h, p= 0.039) and aortic cross-clamp (2.1 ± 0.56 vs. 2.5 ± 0.8 h, p= 0.040) times. Group I’s need for inotropes decreased by 20% (p= 0.044). Postoperative data revealed that Group I had less time in the hospital (5.9 ± 2.9 vs. 7.7 ± 3.4 days, p= 0.037) and intensive care unit (26.3% less duration) and required less time to wean off the mechanical ventilator (18.2 ± 15.7 vs. 45.4 ± 22.7, p<0.001). There was no difference in mortality between the two groups.

Conclusion: In complex cardiac surgery patients with low ejection fraction, modified Del Nido cardioplegia may be as effective as traditional cardioplegia, with the added benefit of shorter cross-clamp and cardiopulmonary bypass times. Additionally, modified Del Nido cardioplegia may result in less inotropic support.