Key result
Modified del Nido cardioplegia shows no 30-day mortality benefit over conventional cardioplegia in low-EF CABG.
Why the study?
The safety of del Nido cardioplegia in adult patients with diminished left ventricular function undergoing isolated coronary artery bypass grafting was uncertain.
Does del Nido cardioplegia provide equivalent short-term outcomes compared to conventional cardioplegia in patients with LVEF ≤ 40% undergoing isolated coronary artery bypass grafting?
Cohort (n=272)
No
Does del Nido cardioplegia provide equivalent short-term outcomes compared to conventional cardioplegia in patients with LVEF ≤ 40% undergoing isolated coronary artery bypass grafting?
Absolute Event Rate: 1.1% vs 3.85%
p-value: p=0.205
Modified del Nido cardioplegia provides equivalent short-term clinical outcomes and shorter bypass times compared to conventional cardioplegia in patients with reduced left ventricular ejection fraction undergoing isolated CABG.
May support modified del Nido cardioplegia in low-EF CABG; leaves open need for RCTs to confirm equivalence.
BACKGROUND: del Nido cardioplegia (DN) has been shown to be safe in adult patients undergoing isolated coronary artery bypass grafting with normal left ventricular ejection fraction. We sought to determine whether it was also safe in adult patients with diminished left ventricular function. METHODS: All patients with preoperative left ventricular ejection fraction ≤ 40% undergoing isolated coronary artery bypass grafting between 1/1/2019 and 7/10/2022 were retrospectively analyzed. Off-pump and beating heart cases were excluded. Patients were divided by surgeon preference between conventional cardioplegia (CCP) and DN. Baseline and intraoperative characteristics and short-term postoperative outcomes were compared. RESULTS: Six surgeons performed 829 isolated coronary artery bypass operations during the study. Two-hundred seventy-two met study criteria. Three surgeons used exclusively CCP for the duration of the study, two used exclusively DN and one switched from CCP to DN mid-way through. Group totals were: CCP n = 181 and DN n = 91. There were no significant differences in baseline characteristics including mean left ventricular ejection fraction (CCP 32.5 ± 7.4% vs. DN 33.4 ± 7.29%, p = 0.939). Other than a significant decrease in bypass time for DN (113.20 ± 37.2 vs. 122.43 ± 34.3 min, p = 0.043) there were no intergroup differences in urgency, number of grafts, ischemic time or incidence of blood transfusion. Postoperative outcomes between CCP and DN were similar including incidence of atrial fibrillation (12.2% vs. 8.8%, p = 0.403), intensive care length of stay (3.7 ± 2.3 vs. 4.3 ± 3.7 days, p = 0.886), total length of stay (5.7 ± 3.7 vs. 6.3 ± 4.4 days, p = 0.922) and 30-day mortality (3.85% vs. 1.10%, p = 0.205). CONCLUSION: Compared to conventional cardioplegia, del Nido cardioplegia provides equivalent short-term outcomes in patients with low left ventricular ejection fraction undergoing isolated coronary artery bypass grafting.
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Brown et al. (2023) conducted a cohort in Poor ventricular function (LVEF ≤ 40%) requiring isolated coronary artery bypass grafting (n=272). Modified del Nido cardioplegia vs. Conventional cardioplegia was evaluated on 30-day mortality (p=0.205). Modified del Nido cardioplegia provided equivalent short-term outcomes, including similar 30-day mortality (1.10% vs 3.85%, p=0.205), compared to conventional cardioplegia in patients with low ejection fraction undergoing isolated CABG.
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