Outcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times
The utility and uptake of Del Nido cardioplegia in adult cardiac surgery is rapidly increasing. Cases with prolonged aortic cross-clamp times necessitate multi-dosing however an understanding of safe ischaemic times and definitive guidelines in this domain are lacking. Therefore, this study aimed to...
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| Veröffentlicht in: | The Journal of extra-corporeal technology 2024-12, Vol.56 (4), p.149-158 |
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| creator | Szpytma, Malgorzata Gimpel, Damian Ross, Jordan Newland, Richard F Crouch, Gareth Rice, Gregory D Bennetts, Jayme S Baker, Robert A |
| description | The utility and uptake of Del Nido cardioplegia in adult cardiac surgery is rapidly increasing. Cases with prolonged aortic cross-clamp times necessitate multi-dosing however an understanding of safe ischaemic times and definitive guidelines in this domain are lacking. Therefore, this study aimed to assess the safety and efficacy of our DNC strategy by comparing post-operative troponin profiles and clinical outcomes between Del Nido and hyperkalaemic cardioplegia for cases with aortic cross-clamp times of greater than 90 min.
A single-centre, retrospective cohort study at Flinders Medical Centre and Flinders Private Hospital of patients undergoing composite cardiac surgery with a cross-clamp time longer than 90 min. Data was prospectively collected from the Flinders Cardiac Surgery Registry from June 2014 to December 2022. A propensity-matched (1:1) analysis was performed comparing patients receiving Del Nido cardioplegia (n = 194) to those receiving hyperkalemic blood cardioplegia (n = 194). The primary outcome was the postoperative troponin release profile with clinical events reported as secondary outcomes.
There was no difference in the peak or median troponin at 6, 12 and 72 h nor the number of patients with positive troponin profiles postoperatively between cohorts. There was no difference in clinical outcomes between groups with aortic cross-clamp times of 90 min which remained true in sensitivity analysis extending out to 120 min. The Del Nido cohort received less cardioplegia volume (p |
| doi_str_mv | 10.1051/ject/2024029 |
| format | Article |
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A single-centre, retrospective cohort study at Flinders Medical Centre and Flinders Private Hospital of patients undergoing composite cardiac surgery with a cross-clamp time longer than 90 min. Data was prospectively collected from the Flinders Cardiac Surgery Registry from June 2014 to December 2022. A propensity-matched (1:1) analysis was performed comparing patients receiving Del Nido cardioplegia (n = 194) to those receiving hyperkalemic blood cardioplegia (n = 194). The primary outcome was the postoperative troponin release profile with clinical events reported as secondary outcomes.
There was no difference in the peak or median troponin at 6, 12 and 72 h nor the number of patients with positive troponin profiles postoperatively between cohorts. There was no difference in clinical outcomes between groups with aortic cross-clamp times of 90 min which remained true in sensitivity analysis extending out to 120 min. The Del Nido cohort received less cardioplegia volume (p < 0.001) and were more likely to return to spontaneous rhythm (p < 0.002).
Del Nido cardioplegia for anticipated aortic cross-clamp times of greater than 90 min provided equivocal post-operative troponin profiles and clinical outcomes compared to multidose hyperkalemic blood cardioplegia.</description><identifier>ISSN: 0022-1058</identifier><identifier>ISSN: 2969-8960</identifier><identifier>EISSN: 2969-8960</identifier><identifier>DOI: 10.1051/ject/2024029</identifier><identifier>PMID: 39705579</identifier><language>eng</language><publisher>France: EDP Sciences</publisher><subject>Aged ; Aorta - surgery ; Cardiac Surgical Procedures - methods ; Cardioplegic Solutions ; Cohort Studies ; Electrolytes ; Female ; Heart Arrest, Induced - methods ; Humans ; Hyperkalemia - blood ; Lidocaine ; Magnesium Sulfate ; Male ; Mannitol ; Middle Aged ; Original ; Potassium Chloride ; Retrospective Studies ; Sodium Bicarbonate ; Solutions ; Treatment Outcome ; Troponin - blood</subject><ispartof>The Journal of extra-corporeal technology, 2024-12, Vol.56 (4), p.149-158</ispartof><rights>The Author(s), published by EDP Sciences, 2024.</rights><rights>The Author(s), published by EDP Sciences, 2024 2024 The Author(s)</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0002-5545-8794 ; 0000-0002-1847-850X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661786/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661786/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39705579$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Szpytma, Malgorzata</creatorcontrib><creatorcontrib>Gimpel, Damian</creatorcontrib><creatorcontrib>Ross, Jordan</creatorcontrib><creatorcontrib>Newland, Richard F</creatorcontrib><creatorcontrib>Crouch, Gareth</creatorcontrib><creatorcontrib>Rice, Gregory D</creatorcontrib><creatorcontrib>Bennetts, Jayme S</creatorcontrib><creatorcontrib>Baker, Robert A</creatorcontrib><title>Outcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times</title><title>The Journal of extra-corporeal technology</title><addtitle>J Extra Corpor Technol</addtitle><description>The utility and uptake of Del Nido cardioplegia in adult cardiac surgery is rapidly increasing. Cases with prolonged aortic cross-clamp times necessitate multi-dosing however an understanding of safe ischaemic times and definitive guidelines in this domain are lacking. Therefore, this study aimed to assess the safety and efficacy of our DNC strategy by comparing post-operative troponin profiles and clinical outcomes between Del Nido and hyperkalaemic cardioplegia for cases with aortic cross-clamp times of greater than 90 min.
A single-centre, retrospective cohort study at Flinders Medical Centre and Flinders Private Hospital of patients undergoing composite cardiac surgery with a cross-clamp time longer than 90 min. Data was prospectively collected from the Flinders Cardiac Surgery Registry from June 2014 to December 2022. A propensity-matched (1:1) analysis was performed comparing patients receiving Del Nido cardioplegia (n = 194) to those receiving hyperkalemic blood cardioplegia (n = 194). The primary outcome was the postoperative troponin release profile with clinical events reported as secondary outcomes.
There was no difference in the peak or median troponin at 6, 12 and 72 h nor the number of patients with positive troponin profiles postoperatively between cohorts. There was no difference in clinical outcomes between groups with aortic cross-clamp times of 90 min which remained true in sensitivity analysis extending out to 120 min. The Del Nido cohort received less cardioplegia volume (p < 0.001) and were more likely to return to spontaneous rhythm (p < 0.002).
Del Nido cardioplegia for anticipated aortic cross-clamp times of greater than 90 min provided equivocal post-operative troponin profiles and clinical outcomes compared to multidose hyperkalemic blood cardioplegia.</description><subject>Aged</subject><subject>Aorta - surgery</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Cardioplegic Solutions</subject><subject>Cohort Studies</subject><subject>Electrolytes</subject><subject>Female</subject><subject>Heart Arrest, Induced - methods</subject><subject>Humans</subject><subject>Hyperkalemia - blood</subject><subject>Lidocaine</subject><subject>Magnesium Sulfate</subject><subject>Male</subject><subject>Mannitol</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Potassium Chloride</subject><subject>Retrospective Studies</subject><subject>Sodium Bicarbonate</subject><subject>Solutions</subject><subject>Treatment Outcome</subject><subject>Troponin - blood</subject><issn>0022-1058</issn><issn>2969-8960</issn><issn>2969-8960</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkUFv1DAQRi0EotvCjXPlIwfSjmPHjk9VVaBFqugFzpbXGe-6OHFqJ63235OySwWnkWaevpnRI-QDgzMGDTu_Rzed11ALqPUrsqq11FWrJbwmK4C6rhaoPSLHpdwDSAacvSVHXCtoGqVXZHc3Ty71WGjy9DNG-j10idqho9vdiPmXjdgHR9cxpY46m7uQxoibYGkYqO3mOO271tEy5w3mHX0K05aOOcU0bLCjNuVpSXA5lVK5aPuRTmFZ-I688TYWfH-oJ-Tn1y8_rm6q27vrb1eXt5VjQssKmYUWvEAtedMKx9YcBUiUjfe1Uh5BcO8sKutwrVqthOKi9a7jgLL2gp-Qi33uOK977BwOU7bRjDn0Nu9MssH8PxnC1mzSo2FMSqZauSR8PCTk9DBjmUwfisMY7YBpLoYzoaRuFgUL-mmP_nk3o3_Zw8A86zLPusxB14Kf_nvbC_zXD_8NCX6UEA</recordid><startdate>202412</startdate><enddate>202412</enddate><creator>Szpytma, Malgorzata</creator><creator>Gimpel, Damian</creator><creator>Ross, Jordan</creator><creator>Newland, Richard F</creator><creator>Crouch, Gareth</creator><creator>Rice, Gregory D</creator><creator>Bennetts, Jayme S</creator><creator>Baker, Robert A</creator><general>EDP Sciences</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5545-8794</orcidid><orcidid>https://orcid.org/0000-0002-1847-850X</orcidid></search><sort><creationdate>202412</creationdate><title>Outcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times</title><author>Szpytma, Malgorzata ; Gimpel, Damian ; Ross, Jordan ; Newland, Richard F ; Crouch, Gareth ; Rice, Gregory D ; Bennetts, Jayme S ; Baker, Robert A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1496-e1a080f4e963584c1b3e406e65ff277fe043fcae7aceb789747348fcd30e62f43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aorta - surgery</topic><topic>Cardiac Surgical Procedures - methods</topic><topic>Cardioplegic Solutions</topic><topic>Cohort Studies</topic><topic>Electrolytes</topic><topic>Female</topic><topic>Heart Arrest, Induced - methods</topic><topic>Humans</topic><topic>Hyperkalemia - blood</topic><topic>Lidocaine</topic><topic>Magnesium Sulfate</topic><topic>Male</topic><topic>Mannitol</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Potassium Chloride</topic><topic>Retrospective Studies</topic><topic>Sodium Bicarbonate</topic><topic>Solutions</topic><topic>Treatment Outcome</topic><topic>Troponin - blood</topic><toplevel>online_resources</toplevel><creatorcontrib>Szpytma, Malgorzata</creatorcontrib><creatorcontrib>Gimpel, Damian</creatorcontrib><creatorcontrib>Ross, Jordan</creatorcontrib><creatorcontrib>Newland, Richard F</creatorcontrib><creatorcontrib>Crouch, Gareth</creatorcontrib><creatorcontrib>Rice, Gregory D</creatorcontrib><creatorcontrib>Bennetts, Jayme S</creatorcontrib><creatorcontrib>Baker, Robert A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of extra-corporeal technology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Szpytma, Malgorzata</au><au>Gimpel, Damian</au><au>Ross, Jordan</au><au>Newland, Richard F</au><au>Crouch, Gareth</au><au>Rice, Gregory D</au><au>Bennetts, Jayme S</au><au>Baker, Robert A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times</atitle><jtitle>The Journal of extra-corporeal technology</jtitle><addtitle>J Extra Corpor Technol</addtitle><date>2024-12</date><risdate>2024</risdate><volume>56</volume><issue>4</issue><spage>149</spage><epage>158</epage><pages>149-158</pages><issn>0022-1058</issn><issn>2969-8960</issn><eissn>2969-8960</eissn><abstract>The utility and uptake of Del Nido cardioplegia in adult cardiac surgery is rapidly increasing. Cases with prolonged aortic cross-clamp times necessitate multi-dosing however an understanding of safe ischaemic times and definitive guidelines in this domain are lacking. Therefore, this study aimed to assess the safety and efficacy of our DNC strategy by comparing post-operative troponin profiles and clinical outcomes between Del Nido and hyperkalaemic cardioplegia for cases with aortic cross-clamp times of greater than 90 min.
A single-centre, retrospective cohort study at Flinders Medical Centre and Flinders Private Hospital of patients undergoing composite cardiac surgery with a cross-clamp time longer than 90 min. Data was prospectively collected from the Flinders Cardiac Surgery Registry from June 2014 to December 2022. A propensity-matched (1:1) analysis was performed comparing patients receiving Del Nido cardioplegia (n = 194) to those receiving hyperkalemic blood cardioplegia (n = 194). The primary outcome was the postoperative troponin release profile with clinical events reported as secondary outcomes.
There was no difference in the peak or median troponin at 6, 12 and 72 h nor the number of patients with positive troponin profiles postoperatively between cohorts. There was no difference in clinical outcomes between groups with aortic cross-clamp times of 90 min which remained true in sensitivity analysis extending out to 120 min. The Del Nido cohort received less cardioplegia volume (p < 0.001) and were more likely to return to spontaneous rhythm (p < 0.002).
Del Nido cardioplegia for anticipated aortic cross-clamp times of greater than 90 min provided equivocal post-operative troponin profiles and clinical outcomes compared to multidose hyperkalemic blood cardioplegia.</abstract><cop>France</cop><pub>EDP Sciences</pub><pmid>39705579</pmid><doi>10.1051/ject/2024029</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-5545-8794</orcidid><orcidid>https://orcid.org/0000-0002-1847-850X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Aged Aorta - surgery Cardiac Surgical Procedures - methods Cardioplegic Solutions Cohort Studies Electrolytes Female Heart Arrest, Induced - methods Humans Hyperkalemia - blood Lidocaine Magnesium Sulfate Male Mannitol Middle Aged Original Potassium Chloride Retrospective Studies Sodium Bicarbonate Solutions Treatment Outcome Troponin - blood |
| title | Outcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times |
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