Commentary: Del Nido cardioplegic solution: Is it really better than any other?

Central MessageDel Nido cardioplegic solution may improve myocardial protection and increase the speed of an operation. However, caution must be taken to maintain optimal during long operations.See Article page 514. Del operations. See The del (DNS) has recently received a large amount attention as method for both pediatric adult patients undergoing cardiac surgery. Although some have proposed that afforded by DNS is actually superior other commonly used solutions, real benefit way up operation limiting times surgeon needs deliver cardioplegia. was originally developed surgery single-dose formula.1del P.J. Cao-Dan H. Sommers K.E. Ohkado A. Patent No. 5,407,793: An Aqueous Heart Preservation Cardioplegia Solution. US Trademark Office, Alexandria, VA1995Google Scholar been studied in patients, its effectiveness adults still under investigation. contains base Plasma-Lyte A (Baxter Healthcare Corp, Deerfield, Ill), which electrolyte composition similar extracellular fluid. In original formulation, concentrations electrolytes before addition additives are 140 mEq/L sodium, 5 potassium, 3 magnesium, 98 chloride, 27 acetate, 23 gluconate, but this modified many clinicians, including authors study consideration. formulation versions serves crystalloid component, mixed with blood at ratio 4 parts 1 part fully oxygenated patient whole blood. Of note, it potassium-rich, lidocaine-containing lower hematocrit level than conventional blood-based cardioplegia only glucose calcium delivered from component. magnesium useful component limit influx sequestration into cells. Lenoir colleagues2Lenoir M. Bouhout I. Jelassi Cartier R. Poirier N. El-Hamamsy et al.del versus aortic root surgery.J Thorac Cardiovasc Surg. 2021; 162: 514-522.e2Abstract Full Text PDF PubMed Scopus (7) Google examine compared traditional on clinical outcomes prolonged Both solutions were initially 4°C different volumes. group, after 60 minutes, additional volume administered if ischemic time anticipated exceed 90 minutes. readministered every 15 20 Myocardial assessed gathering highest postoperative creatine kinase-MB isotype levels troponin T 1, 12, 24, 48 hours groups did well, there trend toward higher group standard (P = .07). >180 median .01). Clinical groups. This suggests operations, repeated delivery required optimize protection. common sense comes down simple chemistry physics. For 3-hour operation, much potassium lidocaine arrests heart will washed out, operating room lights shining heat chicken all-you-can-eat buffet local restaurant. With outcomes, remains uncertain or better other. interesting aspect purported beneficial components also present solution, namely sulfate (2 vs 2.5 g), mannitol (3.26 10 g) (130 40 mg), bicarbonate (13 mEq) respectively. Thus, investigators comparing 2 DNS-like differing same components. Also, surgeons involved volumes very groups, making direct comparisons problematic. timely study, suggesting safe effective short- medium-length setting should consider giving more shots solution. Unfortunately, differences between one left wondering better, they fact efficacy. After all, despite decades investigation ways protect surgery, no single confirmed any really solve issue double-blind randomized controlled trial another surgeryThe Journal Thoracic Cardiovascular SurgeryVol. 162Issue 2PreviewDel offers administration; particularly scarcity data supporting safety complex such repair. We hypothesized provide equivalent Full-Text