del Nido versus blood cardioplegia in cardiac surgery: A multicenter analysis of over 40,000 patients

Robert B Hawkins; James W Stewart 2nd; Xiaoting Wu; Joshua Goldberg; David Fitzgerald; Alphonse DeLucia 3rd; Brittney Graebner; Charles Willekes; Francis D Pagani; Donald H Nieter; Donald S Likosky; Gorav Ailawadi; PERForm Registry and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative

doi:10.1016/j.jtcvs.2023.09.057

del Nido versus blood cardioplegia in cardiac surgery: A multicenter analysis of over 40,000 patients

J Thorac Cardiovasc Surg. 2023 Oct 2:S0022-5223(23)00883-8. doi: 10.1016/j.jtcvs.2023.09.057. Online ahead of print.

Affiliations

¹ Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich. Electronic address: Robertbh@med.umich.edu.
² Department of Surgery, Michigan Medicine, Ann Arbor, Mich; Department of Surgery, Yale School of Medicine, New Haven, Conn.
³ Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
⁴ Department of Cardiac Surgery, Westchester Medical Center, Valhalla, NY.
⁵ Medical University of South Carolina, Charleston, SC.
⁶ University of Michigan Health-West, Wyoming, Mich.
⁷ Perfusion Associates of Michigan, Saginaw, Mich.
⁸ Spectrum Health, Grand Rapids, Mich.
⁹ Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich.

PMID: 37793563
DOI: 10.1016/j.jtcvs.2023.09.057

Abstract

Objectives: The use of del Nido cardioplegia in adult cardiac surgery is rising in popularity. The objective of this large multicenter study was to evaluate the use and associated outcomes of del Nido versus blood cardioplegia in adult cardiac surgery.

Methods: Patients undergoing coronary artery bypass grafting (CABG) and/or valve (mitral, aortic), and/or nondescending thoracic aortic surgery (July 2014 to March 2022) across 39 centers were extracted from the Perfusion Measures and Outcomes registry. Patients were stratified by cardioplegia type for unadjusted analysis and multivariable mixed-effects models were used for risk adjustment.

Results: Of 44,175 patients, 42.5% used del Nido, with use increasing 48% over time. Overall, the del Nido group had shorter median crossclamp time (74 minutes vs 87 minutes, P < .001) and lower median peak intraoperative glucose levels (161 mg/dL vs 180 mg/dL, P < .001). Use of del Nido was not associated with operative mortality (adjusted odds ratio [OR_adj], 1.16; P = .075) nor major morbidity (OR_adj, 1.05; P = .25). Findings for valve cases were similar, except crossclamp time differences were variable by type of valve procedure. Within the CABG subgroup there was a trend toward increased operative mortality with del Nido (OR_adj, 1.24; P = .069), whereas the risk of renal failure approaches statistical significance in the aortic subgroup (OR_adj, 1.54; P = .056).

Conclusions: In this large, multicenter study, the use of del Nido was associated with variable crossclamp time differences, lower intraoperative glucose levels, and no significant difference in major morbidity or mortality. Efficiency benefits of del Nido may be limited in valve cases, whereas outcomes in CABG and aortic cases warrant further study.

Keywords: blood cardioplegia; cardiac protection; del Nido cardioplegia.