Myocardial protection using del nido cardioplegia solution in adult reoperative aortic valve surgery.

BACKGROUND AND AIMS: The immediate postischemic period is marked by elevated intracellular calcium levels, which can lead to irreversible myocyte injury. Del Nido cardioplegia was developed for use in the pediatric population to address the inability of immature myocardium to tolerate high levels of intracellular calcium following cardiac surgery. Our aim in this study is to determine if this solution can be used safely and effectively in an adult, reoperative population. METHODS: All patients undergoing isolated reoperative aortic valve replacement at our institution from 2010 to 2012 were retrospectively reviewed. Demographics, comorbidities, operative variables, postoperative complications, and patient outcomes were collected. Patients were divided into two groups based on cardioplegia strategy used: whole blood cardioplegia (WB, n = 61) and del Nido cardioplegia (DN, n = 52). RESULTS: Mean age in the study was 73.4 ± 14.3 years and 86 patients were male (76.1%). Eighty-four patients had undergone prior coronary artery bypass graft (CABG) (74.3%). Patients in the DN group required significantly lower total volume of cardioplegia (1147.6 ± 447.2 mL DN vs. 1985.4 ± 691.1 mL WB, p < 0.001) and retrograde cardioplegia dose (279.3 ± 445.1 mL DN vs. 1341.2 ± 690.8 mL WB, p < 0.001). There were no differences in cross-clamp time, bypass time, postoperative complication rate, or patient outcomes between groups. CONCLUSIONS: Del Nido cardioplegia use in an adult, reoperative aortic valve population offers equivalent postoperative outcomes when compared with whole blood cardioplegia. In addition, use of del Nido solution requires lower total and retrograde cardioplegia volumes in order to achieve adequate myocardial protection.

Patents and Heart Valve Surgery - III: Percutaneous Heart Valves.

Advancements in technology for the treatment of valvularcardiac diseases seek to provide solutions for high risk patients in the form of percutaneous valve insertion for patients with complicated valvular disease not amenable to more traditional options. Within the last decade, cardiac valves designed for percutaneous insertion have emerged rapidly as a treatment option for valvular disease. This procedure serves as an alternative to open heart surgery, which is more invasive and requires longer ICU stay. Thus, the percutaneous valve insertion procedure has been used on older, frailer patients who are poor candidates for open heart surgery. Designs for percutaneous valve insertion systems have been in development for decades, but have only recently been approved by the FDA for use. Important considerations include stent design, valve design, balloon catheter design, and deployment method.