Del Nido cardioplegia for minimally invasive aortic valve
Michael S. Koeckert MD
Deane E. Smith III MD
Patrick F. Vining BS
Neel K. Ranganath MD
Thomas Beaulieu CCP
Didier F. Loulmet MD
Elias Zias MD
Aubrey C. Galloway MD
Eugene A. Grossi MD
Department of Cardiothoracic Surgery, NYU
School of Medicine, NYU Langone Health,
New York, New York
Deane Smith III MD, Department of
Cardiothoracic Surgery, NYU Langone Health,
530 First Avenue, Suite 9V, New York, NY
Background: We analyzed the impact and safety of del Nido Cardioplegia (DNC) in
patients undergoing minimally invasive aortic valve replacement (MIAVR).
Methods: We analyzed all isolated MIAVR replacements from 5/2013-6/2015
excluding re-operative patients. The approach was a hemi-median sternotomy in all
patients. Patients were divided into two cohorts, those who received 4:1 crystalloid:
blood DNC solution and those in whom standard 1:4 Buckberg-based cardioplegia
(WBC) was used. One-to-one propensity case matching of DNC to WBC was
performed based on standard risk factors and differences between groups were
analyzed using chi-square and non-parametric methods.
Results: MIAVR was performed in 181 patients; DNC was used in 59 and WBC in 122.
Case matching resulted in 59 patients per cohort. DNC was associated with reduced
re-dosing (5/59 (8.5%) versus 39/59 (61.0%), P < 0.001) and less total cardioplegia
volume (1290 ± 347 mL vs 2284 ± 828 mL, P < 0.001). Antegrade cardioplegia alone
was used in 89.8% (53/59) of DNC patients versus 33.9% (20/59) of WBC patients
(P < 0.001). Median bypass and aortic cross-clamp times were similar. Clinical
outcomes were similar with respect to post-operative hematocrit, transfusion
requirements, need for inotropic/pressor support, duration of intensive care unit
stay, re-intubation, length of stay, new onset atrial fibrillation, and mortality.
Conclusions: Del Nido cardioplegia usage during MIAVR minimized re-dosing and the
need for retrograde delivery. Patient safety was not compromised with this technique
in this group of low-risk patients undergoing MIAVR.
aortic valve replacement, cardioplegia, minimally invasive
Del 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 forhyperkalemic arrestand mannitol for free radical scavenging
and for increasing osmolarity to reduce myocyte edema. Additional
additives include magnesium sulfate (a competitive cation preventing
© 2018 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/jocs J Card Surg. 2018;33:64–68.