Del Nido cardioplegia for minimally invasive aortic valve replacement

Del Nido cardioplegia for minimally invasive aortic valve replacement INTRODUCTIONDel Nido cardioplegia (DNC) is a crystalloid based solution developed in the early 1990s for congenital cases, but over recent years interest in its use has grown in the adult population. DNC uses a base solution of plasma‐lyte A, (electrolyte composition similar to extracellular fluid) mixed with oxygenated blood in a 1:4 ratio. Additives include potassium chloride for hyperkalemic arrest and mannitol for free radical scavenging and for increasing osmolarity to reduce myocyte edema. Additional additives include magnesium sulfate (a competitive cation preventing intracellular calcium accumulation), sodium bicarbonate (maintaining intracellular pH and facilitating anaerobic glycolysis), and lidocaine (enhancing the duration of arrest and inhibiting intracellular calcium accumulation by blocking sodium channels). One of the major clinical advantages of DNC is its longer dosing interval with single doses allowing for over one hour of uninterrupted surgery.DNC is well described in the pediatric surgical literature with less need for re‐dosing as well as reduction in post‐operative glucose and troponin. Its use was extended into the adult congenital population and it has been shown to be safe in re‐operative surgery as well as high‐risk CABG. We sought to study the safety of DNC in minimally invasive aortic valve replacement.METHODSPatient selectionInstitutional Review Board http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Cardiac Surgery Wiley

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 Wiley Periodicals, Inc.
ISSN
0886-0440
eISSN
1540-8191
D.O.I.
10.1111/jocs.13536
Publisher site
See Article on Publisher Site

Abstract

INTRODUCTIONDel Nido cardioplegia (DNC) is a crystalloid based solution developed in the early 1990s for congenital cases, but over recent years interest in its use has grown in the adult population. DNC uses a base solution of plasma‐lyte A, (electrolyte composition similar to extracellular fluid) mixed with oxygenated blood in a 1:4 ratio. Additives include potassium chloride for hyperkalemic arrest and mannitol for free radical scavenging and for increasing osmolarity to reduce myocyte edema. Additional additives include magnesium sulfate (a competitive cation preventing intracellular calcium accumulation), sodium bicarbonate (maintaining intracellular pH and facilitating anaerobic glycolysis), and lidocaine (enhancing the duration of arrest and inhibiting intracellular calcium accumulation by blocking sodium channels). One of the major clinical advantages of DNC is its longer dosing interval with single doses allowing for over one hour of uninterrupted surgery.DNC is well described in the pediatric surgical literature with less need for re‐dosing as well as reduction in post‐operative glucose and troponin. Its use was extended into the adult congenital population and it has been shown to be safe in re‐operative surgery as well as high‐risk CABG. We sought to study the safety of DNC in minimally invasive aortic valve replacement.METHODSPatient selectionInstitutional Review Board

Journal

Journal of Cardiac SurgeryWiley

Published: Jan 1, 2018

Keywords: ; ;

References

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