Use of del nido cardioplegia versus St. thomas solution 2 in adult mitral valve replacement surgery at a tertiary care hospital in Kolkata, India

Background: del Nido cardioplegia has been historically used in paediatric cardiac surgery. However it’s use in adults has also been documented. It has the advantage of 90 minutes of cardiac inactivity over St. Thomas solution no.-2, which requires repeated dosing at 20 minutes interval. Aim of this study to find out whether del Nido cardioplegia with longer duration of arrest is advantageous over St. Thomas solution no. 2 in adult mitral valve replacement.Methods: Total 60 patients of severe mixed mitral valve disease of comparable patient profiles, underwent mitral valve replacement with preservation of anterolateral and posteromedial chordae. Half the patients received del Nido cardioplegia and other half received St. Thomas solution no 2. (ST-2). The two groups were compared.Results: del Nido group had lesser CPB time (70.73±12.15min) as compared to ST-2 group (81.76±20.03min) with  p=0.01 ; lesser Cross clamp time (del Nido- 68.8±10.64min; ST-2- 75.83±14.00min) with p=0.02; lesser time taken to arrest heart  (del Nido- 21.58±13.37 sec; ST-2- 25.26±5.27 sec) with p=0.04 & lesser time taken for normal ECG activity to manifest after release of cross clamp (del Nido- 19.86±6.10 min; ST-2- 31.03±5.28min) with p=0.02. All other parameters did not reach statistical significance.Conclusions: del Nido cardioplegia group of patients required significantly less CPB time; Cross-clamp time; Mean time taken to arrest the heart; as well as that taken to manifest normal ECG morphology when compared to ST-2 group

Haemodynamic assessment during off pump coronary artery bypass grafting in patients with ejection fraction ≥40% and it’s relation to myocardial ischaemia in early postoperative period

Background: Subtle haemodynamic alterations that happen during manipulation, displacement and mechanical stabilization of the heart in off pump coronary artery bypass grafting (CABG), may be missed if only conventional parameters like Central venous pressure (CVP); Mean arterial pressure (MAP) and Mean pulmonary arterial pressure (MPAP) are being monitored. In this study we have tried to find out if such alterations may be detected by monitoring cardiac output (CO), cardiac index (CI) and stroke volume (SV) in addition to the conventional parameters.Methods: Over a period of one year (February 2014 to January 2015), 40 patients with left ventricular ejection fraction (LVEF) ≥40%, undergoing off-pump CABG were monitored for the above parameters at baseline and while grafting the anterior, lateral and inferior surfaces of heart. Their quantitative Troponin-I values were also measured preoperatively and 24 hours after shifting to intensive therapy unit (ITU) to find out if the subtle haemodynamic compromises were in anyway related to myocardial injury.Results: CO, CI and SV decreased significantly compared to baseline values while grafting anterior, lateral and inferior surfaces of heart in every patient. MAP decreased significantly only while grafting the left circumflex territory. Only 8 patients showed an elevation of troponin-I value postoperatively (p>0.05).Conclusions: We concluded that during Off-pump CABG (OPCABG) there will be subtle alterations in haemodynamic. However, pharmacological interventions, addition of fluids and lowering head end of table based on the changes seen by the new monitoring parameters are more logically guided and becomes more scientific and objective rather than being just arbitrary decisions