Ahmed Abdelrahman Elassal1, Kkalid Al-Ebrahim2, Osman Al-Radi3, Zaher Faisal Zaher4, Ahmed Mohamed Dohain5, Gaser Abdelmohsen Abdelmohsen4, Ahmed Hasan Abdulla1, Mohamed Atia Meshak4, Mahmoud Akl Abdulaziz1, Mahmoud Salem Eldesouki1, Mohamed Atef Hasan1, Osama Eldib6. 1. Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, Saudi Arabia. samalassal1434@gmail.com. 2. Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, Saudi Arabia. dr.k.ebrahim@gmail.com. 3. Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, Saudi Arabia. oradi@kau.edu.sa. 4. Department of Pediatrics, Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia. samalassal1434@gmail.com. 5. Department of Pediatrics, Cardiology Division, Cairo University, Giza, Egypt. samalassal1434@gmail.com. 6. Cardiothoracic Surgery Department, Zagazig University, Zagazig, Egypt. Eldibcts@gmail.com.
Abstract
BACKGROUND: St. Thomas (ST) and Del Nido (DN) cardioplegic solutions are widely used for myocardial protection during cardiac surgery. In 2016, our university hospital shifted from modified St. Thomas to Del Nido solution for both adult and pediatric cardiac surgery. This retrospective study was conducted to compare ST and DN solutions regarding surgical workflow and clinical outcome in pediatric and adult patients undergoing cardiac surgery. METHODS: We reviewed 220 patients who underwent cardiac surgery requiring cardioplegic arrest. Patients were categorized in 2 groups: ST (n = 110) and DN (n = 110). Each group included 60 pediatric and 50 adult patients. Demographic, intraoperative, and postoperative variables were collected. RESULTS: In pediatric patients, no significant difference was found between the 2 groups regarding clamping time, bypass time, need for defibrillation, inotropic score, postoperative ejection fraction (EF), period of mechanical ventilation, intensive care unit stay, or postoperative arrhythmias. One patient in the ST group required mechanical support by extracorporeal membrane oxygenation. We had 5 cases of pediatric mortality (3 in DN and 2 in ST, P = .64). In adult patients, significantly fewer patients in the DN group needed defibrillation than in the ST group. No significant difference was found regarding clamping time, inotropic score, or intraaortic balloon pump use. Mortality in adult patients was 6 cases (4 in ST group and 2 in DN group). CONCLUSION: DN cardioplegia solution is as safe as ST solution in pediatric and adult cardiac surgery. It has comparable results of myocardial protection and clinical outcome, with superiority regarding uninterrupted surgery and lower rate of defibrillation.
BACKGROUND: St. Thomas (ST) and Del Nido (DN) cardioplegic solutions are widely used for myocardial protection during cardiac surgery. In 2016, our university hospital shifted from modified St. Thomas to Del Nido solution for both adult and pediatric cardiac surgery. This retrospective study was conducted to compare ST and DN solutions regarding surgical workflow and clinical outcome in pediatric and adult patients undergoing cardiac surgery. METHODS: We reviewed 220 patients who underwent cardiac surgery requiring cardioplegic arrest. Patients were categorized in 2 groups: ST (n = 110) and DN (n = 110). Each group included 60 pediatric and 50 adult patients. Demographic, intraoperative, and postoperative variables were collected. RESULTS: In pediatric patients, no significant difference was found between the 2 groups regarding clamping time, bypass time, need for defibrillation, inotropic score, postoperative ejection fraction (EF), period of mechanical ventilation, intensive care unit stay, or postoperative arrhythmias. One patient in the ST group required mechanical support by extracorporeal membrane oxygenation. We had 5 cases of pediatric mortality (3 in DN and 2 in ST, P = .64). In adult patients, significantly fewer patients in the DN group needed defibrillation than in the ST group. No significant difference was found regarding clamping time, inotropic score, or intraaortic balloon pump use. Mortality in adult patients was 6 cases (4 in ST group and 2 in DN group). CONCLUSION:DN cardioplegia solution is as safe as ST solution in pediatric and adult cardiac surgery. It has comparable results of myocardial protection and clinical outcome, with superiority regarding uninterrupted surgery and lower rate of defibrillation.