Application of del Nido cardioplegia in type A aortic dissection surgery

Gao Lanying; Bo Zhiyuan; Chen Jian; Chen Jie; Wang Wei; He Lin; Jia Bin

doi:10.13498/j.cnki.chin.j.ecc.2025.02.03

Abstract：Objective To compare the efficacy of del Nido cardioplegia(DNC)and conventional blood cardioplegia(BCP)in myocardial protection during emergency surgery for acute type A aortic dissection.Methods A retrospective analysis was performed on 151 adults undergoing emergency ATAAD repair at Chengdu Third People's Hospital from January 2020 to August 2024.According to intraoperative cardioplegia,the patients were divided into BCP(n=95)and DNC(n=55)groups.Propensity scorematching(1:1)generated 32 matched pairs with balanced baseline characteristics.Primary endpoints were postoperative 48-hour creatine kinase-MB(CK-MB)and hy-sensitivity troponin T(HS-TnT).Secondary endpoints included postoperative 48-hour lactate dehydrogenase(LDH),creatine kinase(CK),α-hydroxybutyrate dehydrogenase(α-HBDH),left ventricular ejection fraction(LVEF%),mechanical ventilation duration,and ICU stay.A subgroup analysis focused on preoperative myocardial injury(serum CK-MB>4.87 μg/L).Results After matching,no significant differences were observed in 48-hour CK-MB or hs-TnT between BCP and DNC groups(P>0.05).Secondary outcomes,including LVEF,mechanical ventilation time,and ICU stay were comparable.In the preoperative myocardial injury subgroup(BCP:n=66;DNC:n=19),CK-MB(P=0.086)and hs-TnT(P=0.103)remained nonsignificant.However,DNC demonstrated significantly lower postoperative CK(P=0.042)and LDH(P=0.001)compared to BCP.Conclusion DNC and BCP provide equivalent myocardial protection in ATAAD surgery.However,DNC may reduce postoperative myocardial enzyme release in patients with preoperative injury,suggesting its preferential use in high-risk cohorts.