Clinical Outcomes Of Modified Del Nido Cardioplegia In Adult And Pediatric Cardiac Surgery A Multi Center Study.

Original Article

Abstract

Objective: This multicenter cross-sectional study evaluates the clinical outcomes of modified Del Nido cardioplegia in adult and pediatric patients undergoing cardiac surgery.

Study design: A cross-sectional study

Place and Duration of the Study: Allied Health Sciences, Superior University, Lahore, the duration of the study was six months form jan 2024 to june 2024

Methodology: A total of 194 patients (60.8% adults, 39.2% pediatrics) were included, analyzing demographic data, intraoperative parameters, and postoperative outcomes. Key metrics included CPB time, cross-clamp time, cardioplegia volume, left ventricular ejection fraction (LVEF) at discharge, and hospital stay.

Result: This study analyzed 194 patients (60.8% adults and 39.2% pediatrics) undergoing cardiac surgery, with adults having a mean age of 43.19 ± 17.65 years and pediatric patients averaging 6.51 ± 3.49 years (P = 0.001). Males predominated in both groups (41.8% adults, 22.2% pediatrics; P = 0.06), and adults exhibited higher weights (62.9 ± 15.9 kg vs. 16.6 ± 8.3 kg, P = 0.001) and body surface areas (1.63 ± 0.4 m² vs. 0.67 ± 0.2 m², P = 0.001). NYHA class I was significantly more common in pediatrics (92.1% vs. 73.7%, P = 0.005), while smoking history was exclusive to adults (18.4%, P = 0.001). Intraoperatively, adults had longer CPB times (103.2 ± 44.4 min vs. 73.53 ± 41.1 min, P = 0.001) and aortic cross-clamp times (67.5 ± 32.6 min vs. 52.2 ± 32.6 min, P = 0.002), with higher cardioplegia volume and duration (972.4 ± 427.5 ml vs. 393.7 ± 250.9 ml, P = 0.001; 62.9 ± 30.1 min vs. 48.5 ± 31.2 min, P = 0.001). Postoperatively, pediatric patients had higher LVEF at discharge (62.5 ± 4.7% vs. 55.9 ± 9.1%, P = 0.001), while hospital stays were similar (5.7 ± 1.6 days vs. 6.2 ± 2.1 days, P = 0.08). Regression analysis identified CPB time, cardioplegia volume, and cross-clamp time as significant predictors of LVEF at discharge (P < 0.001), emphasising the critical role of intraoperative management, particularly minimising CPB time, in optimising postoperative outcomes.

Conclusion: This study highlights significant differences in intraoperative and postoperative outcomes between adult and paediatric cardiac surgery patients, with CPB time, cross-clamp time, and cardioplegia volume influencing LVEF at discharge. Optimising intraoperative management is crucial to improving cardiac function and recovery in both groups.

Keyword: Modified del nido cardioplegia, Adult, pediatric, cardiac surgery, bypass