Metabolic effect of del nido cardioplegia in ısolated adult coronary artery bypass surgery: A retrospective comparative study

Aim: Del Nido cardioplegia (DNK), initially developed for pediatric cardiac surgery, has recently been applied to adult cardiac surgery. This study retrospectively compared the effects of Del Nido and conventional blood cardioplegia on intraoperative arterial lactate levels and the need for inotropic agents after cardiopulmonary bypass (CPB) in adult patients undergoing isolated elective coronary artery bypass surgery (CABG). Materials and Methods: A retrospective analysis of 1,286 patients who underwent isolated elective CABG at Mersin City Training and Research Hospital between January 2021 and December 2024 was conducted. Based on the inclusion and exclusion criteria, 574 patients were included in the study. These patients were divided into two groups based on the type of cardioplegia administered: Group 1 – DNK (n=287) and Group 2 – conventional blood cardioplegia (n=287). DNK was prepared as a 4:1 blood-crystalloid mixture and administered in a single dose, while conventional cardioplegia was administered in multiple doses. Arterial blood gas samples were taken before KPB (T0), 5 minutes (T1), 20 minutes (T2), 40 minutes (T3), and 10 minutes after weaning from CPB (T4). Lactate levels were compared; preoperative ejection fraction (EF), KPB and cross-clamp times, and post-KPB inotrope requirements were analyzed. Results: There were no significant differences between the groups in terms of age, gender, preoperative EF, KPB duration, and cross-clamp times (p>0.05). Lactate levels were similar at T0, T1, and T2 (p>0.05). However, mean lactate levels were significantly lower in the DNK group compared to the conventional group at T3 and T4 (p<0.001). No significant difference was found in inotrope requirements after CPB (DNK: 32%; Conventional: 34%; p=0.64). Conclusion: Del Nido cardioplegia was associated with lower intraoperative lactate accumulation in adult CABG surgeries. This suggests that DNK provides more effective cellular oxygenation and maintains metabolic balance. In terms of myocardial functional protection, both cardioplegias are equally effective. DNK can be considered a noteworthy alternative in adult cardiac surgery due to its practical applicability, single-dose advantage, and safety.

Amaç: Del Nido kardiyoplejisi (DNK), başlangıçta pediatrik kalp cerrahisi için geliştirilmiş olup, son yıllarda erişkin kalp cerrahisinde de uygulanmaya başlanmıştır. Bu çalışmada, izole elektif koroner arter baypas cerrahisi (KABC) uygulanan erişkin hastalarda Del Nido ve klasik kan kardiyoplejisinin intraoperatif arteriyel laktat düzeylerine etkisi ve kardiyopulmoner baypas (KPB) sonrası inotropik ajan ihtiyacı yönünden retrospektif olarak karşılaştırılmıştır. Gereç ve Yöntem: Ocak 2021 – Aralık 2024 tarihleri arasında Mersin Şehir Eğitim ve Araştırma Hastanesi’nde izole elektif KABC operasyonu geçiren 1.286 hasta retrospektif olarak analiz edildi. Dışlanma ve kabul edilme kriterlerine göre 574 hasta çalışmaya alındı. Bu hastalar uygulanan kardiyopleji tipine göre iki gruba ayrıldı: Grup 1 – DNK (n=287) ve Grup 2 – klasik kan kardiyoplejisi (n=287). DNK, 4:1 oranında kan-kristalloid karışımı olarak hazırlanarak tek dozda, klasik kardiyopleji ise çoklu dozlarda uygulandı. Arteriyel kan gazı örnekleri KPB öncesi (T0), kardiyopleji sonrası 5. dk (T1), 20. dk (T2), 40. dk (T3) ve KPB’den çıkış sonrası 10. dk (T4) zamanlarında alındı. Laktat düzeyleri karşılaştırıldı; ayrıca preoperatif ejeksiyon fraksiyonu (EF), KPB ve kros klemp süreleri ile KPB sonrası inotrop gereksinimi analiz edildi. Bulgular: Yaş, cinsiyet, preoperatif EF, KPB süresi ve kros klemp süreleri açısından gruplar arasında anlamlı fark yoktu (p>0.05). T0, T1 ve T2’de laktat düzeyleri benzerdi (p>0.05). Ancak T3 ve T4’te DNK grubunda ortalama laktat düzeyleri klasik gruba göre anlamlı şekilde daha düşüktü (p<0.001). KPB sonrası inotrop ihtiyacı açısından anlamlı fark saptanmadı (DNK: %32; Klasik: %34; p=0.64). Sonuç: Del Nido kardiyoplejisi, erişkin KABC operasyonlarında intraoperatif dönemde daha düşük laktat birikimi ile ilişkili bulunmuştur. Bu durum, DNK'nin hücresel oksijenlenmeyi daha etkin sağladığını ve metabolik dengeyi koruduğunu düşündürmektedir. Miyokardiyal fonksiyonel koruma açısından ise her iki kardiyopleji eşdeğer etkinlik göstermektedir. DNK, erişkin kalp cerrahisinde pratik uygulanabilirliği, tek doz avantajı ve güvenilirliği ile dikkate değer bir alternatif olarak değerlendirilebilir. Materials and Methods: A retrospective analysis of 1,286 patients who underwent isolated elective CABG at Mersin City Training and Research Hospital between January 2021 and December 2024 was conducted. Based on the inclusion and exclusion criteria, 574 patients were included in the study. These patients were divided into two groups based on the type of cardioplegia administered: Group 1 – DNK (n=287) and Group 2 – conventional blood cardioplegia (n=287). DNK was prepared as a 4:1 blood-crystalloid mixture and administered in a single dose, while conventional cardioplegia was administered in multiple doses. Arterial blood gas samples were taken before KPB (T0), 5 minutes (T1), 20 minutes (T2), 40 minutes (T3), and 10 minutes after weaning from CPB (T4). Lactate levels were compared; preoperative ejection fraction (EF), KPB and cross-clamp times, and post-KPB inotrope requirements were analyzed. Results: There were no significant differences between the groups in terms of age, gender, preoperative EF, KPB duration, and cross-clamp times (p>0.05). Lactate levels were similar at T0, T1, and T2 (p>0.05). However, mean lactate levels were significantly lower in the DNK group compared to the conventional group at T3 and T4 (p<0.001). No significant difference was found in inotrope requirements after CPB (DNK: 32%; Conventional: 34%; p=0.64). Conclusion: Del Nido cardioplegia was associated with lower intraoperative lactate accumulation in adult CABG surgeries. This suggests that DNK provides more effective cellular oxygenation and maintains metabolic balance. In terms of myocardial functional protection, both cardioplegias are equally effective. DNK can be considered a noteworthy alternative in adult cardiac surgery due to its practical applicability, single-dose advantage, and safety.