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Comparison of Post Operative Outcomes Following Del Nido Cardioplegia Versus Howards Cardioplegia in Adult Cardiac Surgery at Pakistan Institute of Medical Sciences

Received: 19 November 2019    Accepted: 18 December 2019    Published: 4 February 2020
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Abstract

This study compares post-operative outcomes for ionotropic support, defibrillator need and duration of hospital stay in adult patients of cardiac surgery following Del Nido cardioplegia versus Howard’s cardioplegia and also compare pre and post operative Cardiac enzymes and serum potassium levels, assessment of pre and post operative Arrthymias. It was an Observational study conducted at Pakistan Institute of Medical Sciences Islamabad Pakistan. Patients were divided into 2 groups. Group (A) patients were Del Nido cardioplegia and Group (B) patients were Howard’s cardioplegia. Data was collected by using non-probability Consecutive Sampling technique. 100 patients were enrolled in this study randomly allocating 50 to each study group. Results of the study show that Post-op CKMB level after 24 hours for Howard group was (127.5200±103.59069) and for DN group (67.3540±23.21292). Similarly post op Potassium level for Howard group was (4.9742±.77010) and for DN group was (4.5590±.65033), Duration of hospital stay for Howard’s group was (9.60±.857) and for DN group was (8.58±1.486). High ionotropic support was required in Howard’s group as compared to DN where it was mild to moderate. 40% patients required defibrillation in Howards as compared to DN with only 20%. It is concluded that Cardioplegia is intended for brief cardiac arrest, which is an important function during cardiopulmonary Bypass surgery. After comparing two cardioplegic solutions namely Del Nido and Howard’s cardioplegia. Our study concludes that Del-Nido cardioplegia provide better myocardial protection and less cross clamp and bypass time. Cardiac enzymes, serum potassium level and post-op arrthymias show better profile in Del-Nido as compared to Howard’s cardiolpegia. Our data clearly advocate the efficacy and safety of Del-Nido over Howard’s cardioplegia. It is very safe and effective as compared to Howards.

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 6, Issue 1)
DOI 10.11648/j.ijcts.20200601.11
Page(s) 1-6
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Cardiopulmonary Bypass, Coronary Artery Disease, Adult Cardiac Surgery, Cardioplegia, Howards, Del-Nido, Cardiac Enzymes

References
[1] Mangiacapra F., De Bruyne B., Wijns W., Bartunek J. Optimizing revascularization strategies in coronary artery disease for optimal benefit to patients. Clin. Pharmacol. Ther. 2011.
[2] Hannan EL, Racz M, Culliford AT, Lahey SJ, Wechsler A, Jordan D, et al. Risk Score for predicting in-hospital/30-day mortality for patients undergoing valve and valve/coronary artery bypass graft surgery. Ann. Thorac. Surg. 2013.
[3] Ben-Gal Y, Stone GW, Smith CR, Williams MR, Weisz G, Stewart AS, et al. On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes: analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. J Thorac Cardiovasc Surg. 2011.
[4] Yerebakan H, Sorabella RA, Najjar M, Castillero E, Mongero L, Beck J, et al. Del Nido Cardioplegia can be safely administered in high-risk coronary artery bypass grafting surgery after acute myocardial infarction: a propensity matched comparison. Journal of Cardiothoracic Surgery 2014.
[5] Richard M. Ginther, Jr., CCP; Ronald Gorney, PA-C, CCP; Joseph M. Forbess, Use of del NidoCardioplegia Solution and a Low-Prime RecirculatingCardioplegia Circuit in Pediatrics. JECT. 2013.
[6] Loberman D, Neely RC, Fitzgerald D, McGurk S, Rajab TK. Modified Del Nido Cardioplegia in Adult Cardiac Surgery; Safety and Efficacy. J Cardiol CurrRes. 2014.
[7] Marill KA, Salcido DD, Sundermann ML, Koller AC, Menegazzi JJ. Potassium cardioplegia during CPR for porcine VF arrest: A blinded randomized controlled trial. 2015.
[8] Guajardo Salinas GE, Nutt R, Rodriguez-Araujo G. Del Nido cardioplegia in low risk adults undergoing first time coronary artery bypass surgery. Perfusion 2016.
[9] Lawton JS. 50th Anniversary Landmark Commentary on Gay WA. Potassium-induced cardioplegia. Ann Thorac Surg 1975; 20: 95–100. Ann Thorac Surg 2015.
[10] Merbel N, Savoie N, Yadav M, et al. Stability: recommendation for best practices and harmonization from the Global Bioanalysis Consortium Harmonization Team. AAPS J. 2014.
[11] Matte GS, del Nido PJ. History and use of del Nido cardioplegia solution at Boston Children’s Hospital. JECT 2012.
[12] Vistarini N, Laliberté E, Beauchamp P, Bouhout I, Lamarche Y, Cartier R, Carrier M, Perrault L, Bouchard D, El-Hamamsy I, Pellerin M, Demers P. Del Nido cardioplegia in the setting of minimally invasive aortic valve surgery. Perfusion. 2017.
[13] Guajardo Salinas GE, Nutt R, Rodriguez-Araujo G. Del Nido cardioplegia in low risk adults un). Charette K, Gerrah R, Quaegebeur J, et al: Single dose myocardial protection technique utilizing del Nido cardioplegia solution during congenital heart surgery procedures. Perfusion 2012.
[14] Govindapillai A, Hua R, Rose R, et al. Protecting the aged heart during cardiac surgery: use of del Nido cardioplegia provides superior functional recovery in isolated hearts. J Thorac Cardiovas Surg 2013.
[15] Smigla G, Jaquiss R, Walczak R, et al. Assessing the safety of del Nidocardioplegia solution in adult congenital cases. Perfusion 2014.
[16] Sanetra K, Pawlak I, Cisowski M. Del Nido cardioplegia - what is the current evidence?. Kardiochir Torakochirurgia Pol. 2018.
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  • APA Style

    Adnan Shah, Attiya Hameed Khan, Hammad Ahmed, Aamir Naveed, Faridullah Khan, et al. (2020). Comparison of Post Operative Outcomes Following Del Nido Cardioplegia Versus Howards Cardioplegia in Adult Cardiac Surgery at Pakistan Institute of Medical Sciences. International Journal of Cardiovascular and Thoracic Surgery, 6(1), 1-6. https://doi.org/10.11648/j.ijcts.20200601.11

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    ACS Style

    Adnan Shah; Attiya Hameed Khan; Hammad Ahmed; Aamir Naveed; Faridullah Khan, et al. Comparison of Post Operative Outcomes Following Del Nido Cardioplegia Versus Howards Cardioplegia in Adult Cardiac Surgery at Pakistan Institute of Medical Sciences. Int. J. Cardiovasc. Thorac. Surg. 2020, 6(1), 1-6. doi: 10.11648/j.ijcts.20200601.11

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    AMA Style

    Adnan Shah, Attiya Hameed Khan, Hammad Ahmed, Aamir Naveed, Faridullah Khan, et al. Comparison of Post Operative Outcomes Following Del Nido Cardioplegia Versus Howards Cardioplegia in Adult Cardiac Surgery at Pakistan Institute of Medical Sciences. Int J Cardiovasc Thorac Surg. 2020;6(1):1-6. doi: 10.11648/j.ijcts.20200601.11

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  • @article{10.11648/j.ijcts.20200601.11,
      author = {Adnan Shah and Attiya Hameed Khan and Hammad Ahmed and Aamir Naveed and Faridullah Khan and Javeed Iqbal and Adnan Tahir},
      title = {Comparison of Post Operative Outcomes Following Del Nido Cardioplegia Versus Howards Cardioplegia in Adult Cardiac Surgery at Pakistan Institute of Medical Sciences},
      journal = {International Journal of Cardiovascular and Thoracic Surgery},
      volume = {6},
      number = {1},
      pages = {1-6},
      doi = {10.11648/j.ijcts.20200601.11},
      url = {https://doi.org/10.11648/j.ijcts.20200601.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20200601.11},
      abstract = {This study compares post-operative outcomes for ionotropic support, defibrillator need and duration of hospital stay in adult patients of cardiac surgery following Del Nido cardioplegia versus Howard’s cardioplegia and also compare pre and post operative Cardiac enzymes and serum potassium levels, assessment of pre and post operative Arrthymias. It was an Observational study conducted at Pakistan Institute of Medical Sciences Islamabad Pakistan. Patients were divided into 2 groups. Group (A) patients were Del Nido cardioplegia and Group (B) patients were Howard’s cardioplegia. Data was collected by using non-probability Consecutive Sampling technique. 100 patients were enrolled in this study randomly allocating 50 to each study group. Results of the study show that Post-op CKMB level after 24 hours for Howard group was (127.5200±103.59069) and for DN group (67.3540±23.21292). Similarly post op Potassium level for Howard group was (4.9742±.77010) and for DN group was (4.5590±.65033), Duration of hospital stay for Howard’s group was (9.60±.857) and for DN group was (8.58±1.486). High ionotropic support was required in Howard’s group as compared to DN where it was mild to moderate. 40% patients required defibrillation in Howards as compared to DN with only 20%. It is concluded that Cardioplegia is intended for brief cardiac arrest, which is an important function during cardiopulmonary Bypass surgery. After comparing two cardioplegic solutions namely Del Nido and Howard’s cardioplegia. Our study concludes that Del-Nido cardioplegia provide better myocardial protection and less cross clamp and bypass time. Cardiac enzymes, serum potassium level and post-op arrthymias show better profile in Del-Nido as compared to Howard’s cardiolpegia. Our data clearly advocate the efficacy and safety of Del-Nido over Howard’s cardioplegia. It is very safe and effective as compared to Howards.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Comparison of Post Operative Outcomes Following Del Nido Cardioplegia Versus Howards Cardioplegia in Adult Cardiac Surgery at Pakistan Institute of Medical Sciences
    AU  - Adnan Shah
    AU  - Attiya Hameed Khan
    AU  - Hammad Ahmed
    AU  - Aamir Naveed
    AU  - Faridullah Khan
    AU  - Javeed Iqbal
    AU  - Adnan Tahir
    Y1  - 2020/02/04
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ijcts.20200601.11
    DO  - 10.11648/j.ijcts.20200601.11
    T2  - International Journal of Cardiovascular and Thoracic Surgery
    JF  - International Journal of Cardiovascular and Thoracic Surgery
    JO  - International Journal of Cardiovascular and Thoracic Surgery
    SP  - 1
    EP  - 6
    PB  - Science Publishing Group
    SN  - 2575-4882
    UR  - https://doi.org/10.11648/j.ijcts.20200601.11
    AB  - This study compares post-operative outcomes for ionotropic support, defibrillator need and duration of hospital stay in adult patients of cardiac surgery following Del Nido cardioplegia versus Howard’s cardioplegia and also compare pre and post operative Cardiac enzymes and serum potassium levels, assessment of pre and post operative Arrthymias. It was an Observational study conducted at Pakistan Institute of Medical Sciences Islamabad Pakistan. Patients were divided into 2 groups. Group (A) patients were Del Nido cardioplegia and Group (B) patients were Howard’s cardioplegia. Data was collected by using non-probability Consecutive Sampling technique. 100 patients were enrolled in this study randomly allocating 50 to each study group. Results of the study show that Post-op CKMB level after 24 hours for Howard group was (127.5200±103.59069) and for DN group (67.3540±23.21292). Similarly post op Potassium level for Howard group was (4.9742±.77010) and for DN group was (4.5590±.65033), Duration of hospital stay for Howard’s group was (9.60±.857) and for DN group was (8.58±1.486). High ionotropic support was required in Howard’s group as compared to DN where it was mild to moderate. 40% patients required defibrillation in Howards as compared to DN with only 20%. It is concluded that Cardioplegia is intended for brief cardiac arrest, which is an important function during cardiopulmonary Bypass surgery. After comparing two cardioplegic solutions namely Del Nido and Howard’s cardioplegia. Our study concludes that Del-Nido cardioplegia provide better myocardial protection and less cross clamp and bypass time. Cardiac enzymes, serum potassium level and post-op arrthymias show better profile in Del-Nido as compared to Howard’s cardiolpegia. Our data clearly advocate the efficacy and safety of Del-Nido over Howard’s cardioplegia. It is very safe and effective as compared to Howards.
    VL  - 6
    IS  - 1
    ER  - 

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Author Information
  • Department of Cardiac Surgery at Pakistan Institute of Medical Sciences, Bashir Institute of Health Sciences Affiliated with Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

  • Department of Cardiac Surgery at Pakistan Institute of Medical Sciences, Bashir Institute of Health Sciences Affiliated with Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

  • Department of Cardiac Surgery at Pakistan Institute of Medical Sciences, Bashir Institute of Health Sciences Affiliated with Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

  • Department of Cardiac Surgery at Pakistan Institute of Medical Sciences, Bashir Institute of Health Sciences Affiliated with Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

  • Department of Cardiac Surgery at Pakistan Institute of Medical Sciences, Bashir Institute of Health Sciences Affiliated with Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

  • Department of Cardiac Surgery at Pakistan Institute of Medical Sciences, Bashir Institute of Health Sciences Affiliated with Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

  • Department of Cardiac Surgery at Pakistan Institute of Medical Sciences, Bashir Institute of Health Sciences Affiliated with Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

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