Del Nido and Buckberg cardioplegia in coronary artery bypass patients: single-center prospective study
Abstract
Aim of the study - compare the effectiveness of myocardial protection when
using del Nido and Buckberg cardioplegia in patients with ischemic heart
disease.
Material and methods. Prospective, single-center non-randomized study. The study included 150
patients (del Nido - 75 patients, Buckberg - 75 patients). In each group, 57
patients underwent isolated coronary bypass surgery, and 18 patients
underwent combined coronary bypass surgery with prosthetics/plastic
surgery of one of the heart valves.
Results. Average total number of grafts (2.7±0.09 in the del Nido group and 2.7±0.09
in the Buckberg group, p=0.95) and
the average number of arterial grafts (1.05±0.06 in the del Nido group and 1.12±0.08
in the Buckberg group, p=0.59) did
not differ significantly. In the del Nido group, the aortic cross-clamping
time (63.8±26 vs to 74.6±37 minutes in the group of Buckberg, p=0.02), the total time of
extracorporeal circulation (98.7±33 vs 115.3±46 minutes, p=0.008), time of extracorporeal circulation after aortic
cross-clamping (30.4±11 vs 34.4±10 min, p=0.007) and total time of
operation (of 221.8±45 vs 251.7±65 min, p=0.008)
were significantly lower than in the Buckberg group. The frequency of
spontaneous recovery of normal rhythm after removal of aortic
transverse clamp (90.7 vs 84%), development of ventricular fibrillation
(12 vs 14.7%) and intraoperative defibrillation (9.3 vs 14.7%) did not differ
statistically significantly (p>0.05).
In the postoperative period, the duration of inotropic/vasopressor
support, stay in the ICU and the total period of hospitalization did not differ
statistically (p>0.05). Dependence
on an artificial pacemaker in the postoperative period (2.7 vs 13.5%, p=0.01) and paroxysms of atrial
fibrillation were more frequently observed in the Buckberg group (14.7 vs
26.7%, p=0.07). The level of CK-MB in
12-16 hours after surgery was lower in the del Nido group (26.3±17 vs
45.1+60 U/l, p=0.0002).
Conclusion. del Nido cardioplegia is safe and effective in patients with coronary
artery disease. In comparison with Buckberg cardioplegia, the use of del Nido
cardioplegia might reduce extracorporeal circulation, cross-clamping and the
total operation time. We determined that in the del Nido group, CK-MB
values were significantly lower in the early postoperative period, which
positively characterizes the protective properties of this method. In
addition, the del Nido group showed a lower rate of dependence on a
temporary artificial pacemaker in the early postoperative period.
Keywords:cardiac surgery, coronary bypass surgery, myocardial protection, cardioplegia, del Nido, Buckberg
Funding. The study had no
sponsor support.
Conflict of interest. The authors
declare no conflict of interest.
For citation: Klyshko N.K.,
Furgal A.A., Shchava S.P., Silaev A.A., Zenina A.A., Savushkina N.V.,
Kondrashova N.M., Stepanov E.V., Goncharuk R.A., Sorokin V.A. Del Nido and
Buckberg cardioplegia in coronary artery bypass patients: singlecenter
prospective study. Clinical and Experimental Surgery. Petrovsky Journal. 2021;
9 (2): 76-83. DOI: https://doi.org/10.33029/2308-1198-2021-9-2-76-83 (in Russian)
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