Adult: Coronary: Basic Science
Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegic solutions in minimally invasive cardiac surgery

Accepted for the 100th Annual Meeting of The American Association for Thoracic Surgery.
https://doi.org/10.1016/j.jtcvs.2020.11.163Get rights and content

Abstract

Objective

We examined the safety and efficacy of del Nido cardioplegic solution compared with histidine-tryptophan-ketoglutarate cardioplegic solution in minimally invasive cardiac surgery.

Methods

Patients who underwent minimally invasive cardiac surgery using del Nido or histidine-tryptophan-ketoglutarate from 2015 to 2019 were enrolled. Various clinical outcomes were compared between the groups. Postoperative laboratory findings including the levels of electrolytes, cardiac enzymes (creatine kinase-MB and troponin I), and serial blood lactate were also measured and compared. Based on 28 baseline covariates, propensity score matching was performed to reduce selection bias.

Results

Among 766 patients, del Nido and histidine-tryptophan-ketoglutarate were used in 330 patients (43.1%) and 436 patients (56.9%), respectively. There were no significant intergroup differences in postoperative clinical outcomes and early adverse outcomes among 228 pairs of propensity score–matched patients. Immediate postoperative sodium levels were within the normal range in both groups without a significant difference (P = .50). However, peak creatine kinase-MB (median, 31.9 vs 37.7 ng/mL, P = .026) and troponin I (6.9 vs 9.1 ng/mL, P = .014) levels were significantly lower in the del Nido group. Linear regression analysis revealed a significant association between the peak cardiac enzyme levels and the cardiac ischemic time depending on the cardioplegia type, with lower cardiac isoenzymes for del Nido over histidine-tryptophan-ketoglutarate (P < .001) until the crossover point at the cardiac ischemic time over 100 minutes.

Conclusions

In comparison with histidine-tryptophan-ketoglutarate solution, del Nido solution seems to have acceptable safety and efficacy with good myocardial protection in minimally invasive cardiac surgery. Further studies focusing on complex surgeries requiring longer cardiac ischemic time are needed.

Graphical abstract

The scheme of a retrospective study on comparison of DN and HTK cardioplegic solutions in minimally invasive cardiac surgery. Propensity score matching yielded 228 pairs of patients, and no significant intergroup differences in postoperative clinical outcomes and early adverse outcomes were found. However, peak cardiac enzyme levels were significantly lower in the DN group until the crossover point at the cardiac ischemic time over 100 minutes.

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Section snippets

Study Population

The study identified a total of 1014 adult patients (age ≥ 17 years) who underwent cardiac surgery through a minimally invasive approach requiring cardiac arrest with HTK or DN cardioplegic solutions from May 2015 to February 2019 in the Institutional Cardiac Surgical Database of Asan Medical Center, Seoul, Korea. MICS was defined as a cardiac operation requiring cardiac arrest, which is performed through right lateral minithoracotomy, right anterior minithoracotomy, or partial sternotomy

Baseline Characteristics

The baseline characteristics of the overall cohort are summarized in Table 1. In comparison with patients in the HTK group, patients in the DN group were older (P = .012) and had greater left ventricular (LV) mass (P = .002). The proportions of patients with male gender (P = .029), diabetes (P = .001), and hypertension (P = .032) were higher in the DN group. Other baseline profiles, including European System for Cardiac Operative Risk Evaluation II, did not show statistically significant

Discussion

The present study found that the use of DN and HTK showed similar safety in MICS. Early clinical outcomes and major adverse outcomes showed no significant differences between the 2 groups. Postoperative serum lactic acid levels and postoperative VIS were used as indicators of postoperative hemodynamic stability, and these also did not show significant differences between the 2 groups. Although DN and HTK cardioplegic solutions consist of discrete electrolytes and buffering agents (extracellular

Conclusions

In comparison with HTK cardioplegic solution, DN cardioplegic solution seems to have acceptable safety and efficacy with good myocardial protection in the setting of MICS.

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    Institutional Review Board approval: 2020-02-04, S2019-0421-0002

    C-h.L and Y.K. contributed equally as first authors to this study. J.W.L. and J.B.K. have contributed equally as corresponding authors to this study.

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