Int J Angiol 2024; 33(01): 029-035
DOI: 10.1055/s-0039-3400747
Original Article

Whole Blood del Nido versus Cold Blood Microplegia in Adult Cardiac Surgery: A Propensity-Matched Analysis

Taylor M. James
1   Graduate Medical Education MD/MPH Program, University of Miami Miller School of Medicine, Miami, Florida
2   Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida
Cristiano Faber
2   Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida
Marcos A. Nores
2   Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida
› Institutsangaben
Funding None.


Objectives Few studies have evaluated the outcomes of whole blood microplegia in adult cardiac surgery. Our novel protocol includes removing the crystalloid portion and using the Quest Myocardial Protection System (MPS) for the delivery of del Nido additives in whole blood. This study sought to compare early and late clinical outcomes of whole blood del Nido microplegia (BDN) versus cold blood cardioplegia (CBC) following adult cardiac surgery.

Materials and Methods A total of 361 patients who underwent cardiac surgery using BDN were compared with a contemporaneous control group of 934 patients receiving CBC. Propensity matching yielded 289 BDN and 289 CBC patients. Chi-square analysis and Fisher's exact test were performed to compare preoperative, operative, and postoperative characteristics on the matched data. Primary outcome was operative mortality, and secondary outcomes included clinical outcomes such as stroke, cardiac arrest, and intra-aortic balloon pump use. The Kaplan–Meier method was used to compare actuarial survival between the two groups using a log-rank test.

Results After matching, preoperative characteristics and surgery type were similar between groups. Cardioplegia type did not affect the primary end point of operative mortality. The rate of postoperative intra-aortic balloon pump was lower in BDN patients compared with CBC patients (0 vs. 2%; p = 0.01). There was no difference in late survival.

Conclusion Our novel protocol BDN was comparable with CBC, with similar clinical outcomes and no difference in operative mortality or actuarial survival. Further studies should evaluate the long-term outcomes of this technique.


Artikel online veröffentlicht:
31. Dezember 2019

© 2019. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

  • References

  • 1 Buckberg GD, Athanasuleas CL. Cardioplegia: solutions or strategies?. Eur J Cardiothorac Surg 2016; 50 (05) 787-791
  • 2 Mick SL, Robich MP, Houghtaling PL. et al. del Nido versus Buckberg cardioplegia in adult isolated valve surgery. J Thorac Cardiovasc Surg 2015; 149 (02) 626-634 , discussion 634–636
  • 3 Nardi P, Pisano C, Bertoldo F, Ruvolo G. New insights on the use of del Nido cardioplegia in the adult cardiac surgery. J Thorac Dis 2018; 10 (Suppl. 26) S3233-S3236
  • 4 Matte GS, del Nido PJ. History and use of del Nido cardioplegia solution at Boston Children's Hospital. J Extra Corpor Technol 2012; 44 (03) 98-103
  • 5 Stamou SC, Lopez C, Novello C, Nores MA. Modified whole blood microplegia in high-risk patients. J Card Surg 2019; 34 (03) 118-123
  • 6 Charette K, Gerrah R, Quaegebeur J. et al. Single dose myocardial protection technique utilizing del Nido cardioplegia solution during congenital heart surgery procedures. Perfusion 2012; 27 (02) 98-103
  • 7 O'Blenes SB, Friesen CH, Ali A, Howlett S. Protecting the aged heart during cardiac surgery: the potential benefits of del Nido cardioplegia. J Thorac Cardiovasc Surg 2011; 141 (03) 762-770
  • 8 Edelman JJB, Seco M, Dunne B. et al. Custodiol for myocardial protection and preservation: a systematic review. Ann Cardiothorac Surg 2013; 2 (06) 717-728
  • 9 Harvey B, Shann KG, Fitzgerald D. et al; American Society of ExtraCorporeal Technology's International Consortium for Evidence-Based Perfusion and Pediatric Perfusion Committee. International pediatric perfusion practice: 2011 survey results. J Extra Corpor Technol 2012; 44 (04) 186-193
  • 10 Valooran GJ, Nair SK, Chandrasekharan K, Simon R, Dominic C. del Nido cardioplegia in adult cardiac surgery - scopes and concerns. Perfusion 2016; 31 (01) 6-14
  • 11 McCann II UG, Lutz CJ, Picone AL. et al. Whole blood cardioplegia (minicardioplegia) reduces myocardial edema after ischemic injury and cardiopulmonary bypass. J Extra Corpor Technol 2006; 38 (01) 14-21
  • 12 Ferguson ZG, Yarborough DE, Jarvis BL, Sistino JJ. Evidence-based medicine and myocardial protection--where is the evidence?. Perfusion 2015; 30 (05) 415-422
  • 13 Algarni KD, Weisel RD, Caldarone CA, Maganti M, Tsang K, Yau TM. Microplegia during coronary artery bypass grafting was associated with less low cardiac output syndrome: a propensity-matched comparison. Ann Thorac Surg 2013; 95 (05) 1532-1538
  • 14 Loberman D, Neely RC, Fitzerald D. Modified del Nido cardioplegia in adult cardiac surgery; safety and efficacy. J Cardiol Curr Res 2014; 1: 00042
  • 15 Rizoli S. PlasmaLyte. J Trauma 2011; 70 (5, suppl): S17-S18
  • 16 Mack MC, Szerlip M, Herbert MA. et al. Outcomes of treatment of nonagenarians with severe aortic stenosis. Ann Thorac Surg 2015; 100 (01) 74-80
  • 17 Albacker TB, Chaturvedi R, Al Kindi AH. et al. The effect of using microplegia on perioperative morbidity and mortality in elderly patients undergoing cardiac surgery. Interact Cardiovasc Thorac Surg 2009; 9 (01) 56-60
  • 18 Stammers AH, Vang SN, Mejak BL, Rauch ED. Quantification of the effect of altering hematocrit and temperature on blood viscosity. J Extra Corpor Technol 2003; 35 (02) 143-151
  • 19 Velez DA, Morris CD, Budde JM. et al. All-blood (miniplegia) versus dilute cardioplegia in experimental surgical revascularization of evolving infarction. Circulation 2001; 104 (12, suppl 1): I296-I302
  • 20 Onorati F, Santini F, Dandale R. et al. “Polarizing” microplegia improves cardiac cycle efficiency after CABG for unstable angina. Int J Cardiol 2013; 167 (06) 2739-2746
  • 21 Stamou SC, Jablonski KA, Garcia JM, Boyce SW, Bafi AS, Corso PJ. Operative mortality after conventional versus coronary revascularization without cardiopulmonary bypass. Eur J Cardiothorac Surg 2004; 26 (03) 549-553
  • 22 Kirmani BH, Holmes MV, Muir AD. Long-term survival and freedom from reintervention after off-pump coronary artery bypass grafting: a propensity-matched study. Circulation 2016; 134 (17) 1209-1220
  • 23 Kim YH, Czer LS, Soukiasian HJ. et al. Ischemic mitral regurgitation: revascularization alone versus revascularization and mitral valve repair. Ann Thorac Surg 2005; 79 (06) 1895-1901
  • 24 Govindapillai A, Hancock Friesen C, O'Blenes SB. Protecting the aged heart during cardiac surgery: single-dose del Nido cardioplegia is superior to multi-dose del Nido cardioplegia in isolated rat hearts. Perfusion 2016; 31 (02) 135-142
  • 25 Sorabella RA, Akashi H, Yerebakan H. et al. Myocardial protection using del Nido cardioplegia solution in adult reoperative aortic valve surgery. J Card Surg 2014; 29 (04) 445-449
  • 26 Timek T, Willekes C, Hulme O. et al. Propensity matched analysis of del Nido cardioplegia in adult coronary artery bypass grafting: initial experience with 100 consecutive patients. Ann Thorac Surg 2016; 101 (06) 2237-2241