Cardioplegia, anaesthetics and operative management
In July/2017 we started using DNC and due to perceived advantage in terms of shorter cross clamp and CPB times and improved surgical workflow of the procedure along with the increasing evidence for its safety and advantages in adult cardiac surgery arena, we adopted it for routine use in all adult cardiac surgery procedures whenever is available. If DNC was out of stock, we used our usual multi-dose undiluted cold BC. Between July/2017 and November/2019, 305 consecutive patients were included in this study. DNC was used in 231 patients and cold BC was used in 74 patients.
Because we shifted completely to use of DNC in all cases whenever is available, there are fewer patients in the blood cardioplegia group. The components of both DNC and cold BC are detailed in Supplemental Table S1.
With the exception of the cardioplegia type, techniques for myocardial protection, cooling, cardiopulmonary bypass, and surgical techniques were similar between the two groups which were all performed by a single surgeon (KDA). All patients in both groups received antegrade cardioplegia (in the root or directly in coronary ostia in patients with significant aortic regurgitation). Topical ice slush was used liberally in all cases. Details of the cardioplegic technique, anesthetics and operative management are provided in the Supplement .