Clinical experience summary of modified del Nido cardioplegia for video-assisted right subaxillary minimally invasive cardiac surgery

Hu Zhibin; Mao Wenshuai; Guo Lijun; Liu Zhiwei; Ge Genxian; Wang Shuwei; Liu Zhifang; Zhou Bing; Cui Yong

doi:10.13498/j.cnki.chin.j.ecc.2024.02.04

Abstract：Objective To summarize the myocardial protective effect of modified del Nido cardioplegia(MDNC)for video-assisted right subaxillary minimally invasive cardiac surgery.Methods A MDNC consisting of 4 parts blood and 1 part del Nido Cardioplegia was used for video-assisted right subaxillary minimally invasive cardiac surgery since 2018 to 2022.Our myocardial protection strategy consisted of single-dose MDNC perfused if aortic cross-clamp(ACC)time within 90 minutes and reperfused per 60 minutes if ACC time over 90 minutes.Retrospective analysis of the patients'clinical data including preoperative basic characteristics,intraoperative data,postoperative cTnI,postoperative outcome and so on were conducted.Results During 5 years,Minimally invasive cardiac surgery using MDNC was performed in 908 cases.Major perioperative indicators including:1)Spontaneous rhythms recovery rate was 93.28%.2)All patients had a significant increase in cTnI in the 24h postoperative period(P<0.05).Patients were divided into three groups according to perfused interval time,groupⅠ:≤60 minutes,group Ⅱ:between 61-90 minutes,group Ⅲ:>90 minutes.The difference in cTnI between groups Ⅰ andⅡ was not statistically significant when ACC time was within 90 minutes(Z =-1.572,P = 0.116).In patients with over 90 minutes of ACC time,cTnI increased with longer perfusion intervals.The difference between the group Ⅱ and group Ⅲ was not statistically significant,but the cTnI in the two groups were significantly higher than the group Ⅰ(Z =-2.232,P = 0.026,Z =-2.569,P = 0.010).3)Minimally invasive cardiac surgery had a good outcome,with a mortality rate of only 1.87%at 30d postoperatively.Conclusion In our initial experience,single-dose perfusion of MDNC for video-assisted right subaxillary minimally invasive cardiac surgery can prolong the time of cardiac arrest.Intermittent myocardial reperfusion at 60-min intervals and single dose perfusion for up to 90 min are safe and effective.