A decade of reoperative adult cardiac surgery with Del Nido cardioplegia.

Abstract

To evaluate the safety and efficacy of del Nido cardioplegia (DN) and blood cardioplegia (BC) in adult reoperations over a 10-year period. Between April 2014 and March 2024, 696 adult patients underwent cardiac reoperations at our center with DN (N = 325) or BC (N = 369). Propensity score matching by preoperative characteristics yielded 287 pairs. The primary outcome was myocardial protection, as assessed by postoperative cardiac troponin T (cTnT) level and left ventricular ejection fraction (LVEF). Secondary outcomes included 30-day complications and long-term survival. The matched cohorts were balanced in demographics, risk factors, operative status, and surgical indication. DN was associated with shorter aortic cross-clamp (AXC) times (mean, 121 ± 60 minutes vs 189 ± 87 minutes; P < .0001) and cardiopulmonary bypass times (mean, 177 ± 90 minutes vs 256 ± 111 minutes; P < .0001) and lower intraoperative glucose levels (mean, 176 ± 43 mg/dL vs 195 ± 51 mg/dL; P < .0001). Thirty-day mortality, stroke, renal failure, atrial fibrillation, and the need for mechanical circulatory support were similar in the 2 cohorts. Subgroup stratification by AXC time found lower cTnT with DN when AXC was <120 minutes (median, 0.3 [interquartile range (IQR), 0.2-0.6] ng/mL vs 0.4 [IQR, 0.3-0.7] ng/mL; P = .0257), but no difference at 121 to 180 minutes or ≥180 minutes. Follow-up echocardiography was available in 91.1% at a mean of 2.8 ± 2.7 years and revealed comparable mean LVEF (DN: 52.3 ± 13.2%; BC: 52.5 ± 13.1%; P = .8247). Nine-year survival was equivalent in the 2 groups (63.2% vs 65.3%; P = .7913). Compared to BC, DN cardioplegia offered comparable myocardial protection and perioperative outcomes overall and equivalent 9-year survival in adult cardiac reoperations. However, AXC-stratified analysis revealed clinically relevant subgroup differences that warrant further investigation.