Effect of del nido cardioplegia use on kidney injury after coronary bypass operations

SUMMARY OBJECTIVE: After cardiac surgery, acute kidney injury is observed at a rate of 5-30%, and the second most common cause of acute kidney injury in intensive care units is cardiac surgery. In this study, we aimed to investigate the effect of del Nido cardioplegia solution use on postoperative acute kidney injury development in patients who underwent coronary artery bypass grafting operation with cardiopulmonary bypass. METHODS: Consecutive patients who underwent an elective coronary artery bypass grafting operation with cardiopulmonary bypass in our clinic between March 15, 2019, and March 15, 2020, were included in the study retrospectively. The patients were divided into two groups as those who received del Nido cardioplegia solution (Group 1) and blood cardioplegia (Group 2), and factors affecting the development of renal failure were examined. RESULTS: A total of 350 consecutive patients were included in the study. There were 156 patients in the del Nido cardioplegia group and 194 patients in the blood cardioplegia group. Among the patient group, 74 (21.1%) patients developed acute kidney injury. The total acute kidney injury development rate was significantly higher in Group 2 (p=0.018). In multivariate logistic regression analysis, advanced age (OR 1.128; 95%CI 1.044-1.217; p=0.042), increased blood product use (OR 1.318; 95%CI 1.154-1.998; p=0.019), preoperative creatinine elevation (OR 2.434; 95%CI 1.655-4.639; p=0.005), and increased cardioplegia volume (OR 1.254; 95%CI 1.109-2.980; p=0.009) were independent predictors of acute kidney injury. CONCLUSION: With this study, we showed that the use of del Nido cardioplegia solution can reduce the incidence of acute kidney injury.

Comparison of del nido cardioplegia and blood cardioplegia in terms of development of postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting

Abstract Objective: Del Nido cardioplegia (DNC) has been used in pediatric cardiac surgery for many years with a single dose application and its usage in adult cardiac surgery has been increasing in recent years, with results being published. In this study, we aimed to investigate the effect of DNC on the development of postoperative atrial fibrillation (PoAF). Methods: In this retrospective observational comparative study, 255 patients who underwent isolated on-pump coronary artery bypass grafting, between January 2019 and November 2019, were enrolled. The patients were divided into two groups: DNC (n=132) and blood cardioplegia (BC) (n=123). Intraoperative and postoperative data were evaluated and compared in terms of the development of PoAF. Results: We found that the development of PoAF and the length of hospital stay remain significantly higher in the BC group (P=0.044, P<0.001, respectively). In addition, the aortic cross-clamp time and the cardioplegia volume delivered were significantly lower in the DNC group (P=0.042, P<0.001, respectively). In multivariate logistic regression analysis, only higher cardioplegia volume was determined as an independent predictor for PoAF development (OR 1.001; 95% CI 1.000-1.001; P=0.033). We did not found difference between groups in terms of troponin T, inotropic drug support, need for intraaortic balloon pump and mortality. Conclusion: This study showed that DNC can be used safely in adult coronary bypass surgery and PoAF development effect is reduced.

Soluciones cristaloides y coloides, como sustitutas de la sangre en el cebado del circuito extracorpóreo durante la cirugía cardiovascular / Crystalloid and colloidal solutions as blood substitutes in the priming of the extracorporeal circuit during cardiovascular surgery

Se realizó un estudio cualitativo donde se exponen las características principales, objetivos de aplicación y las ventajas que ofrecen las diferentes soluciones coloidales y electrolíticas utilizadas en el cebado del circuito extracorpóreo. Como objetivo principal se exponen los argumentos necesarios que permiten al perfusionista combinar determinadas soluciones, para conservar la osmolaridad, la presión oncótica del plasma, mejorar el flujo microcirculatorio y evitar las transfusiones de sangre y hemoderivados innecesarias. También se mencionan diferentes técnicas para conservar el nivel del hematócrito, como son el uso de hemofiltros, concentrador de células y la aplicación de la cardioplejia sanguínea, que aunque su principal objetivo es la protección miocárdica, también sustituye los grandes volúmenes de líquido que caracteriza el uso de la cardioplejia cristaloide(AU)

The chief characteristics, objectives of application and the advantages the colloidal and electrolytic solutions used in the priming of the extracorporeal circuit offer are explained in this qualitative study. The necessary arguments that allow the perfusionist to combine certain solutions to conserve osmolarity, the oncotic pressure of plasma, to improve the microcirculatory flow and to avoid blood transfusions and unnecessary hemoderivatives, are dealt with as the fundamental aim. Reference is made to different techniques used to conserve the haematocrit level, such as: the use of haemofilters, cell concentrator and the application of blood cardioplegia, whose main goal is the myocardial protection, but it also substitutes the great volumes of fluid that characterize the use of crystalloid cardioplegia(AU)