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 .