Del Nido for Organ Procurement?

CPG

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FA 2016

Editor’s Note:

I got this question posed to me via FB from Grant Catlett, CCP.

Question for you.

Awhile back you posted the results of a survey for solutions used during heart procurement. On that list was del nido. We have been using del nido for all of our adult hearts for the past 3 years but have never used it for procurement.

Would you happen to know what centers are using it for organ harvest?

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JECT

Click image to view Source Article

Del Nido Cardioplegia: A Brief Review:

 

Abstract:

Cardiac arrest by cardioplegia provides a reproducible and safe method to induce and maintain electromechanical cardiac quiescence. Techniques of intraoperative myocardial protection are constantly evolving. For the past three decades, modified Buckberg cardioplegia solution has been used for adult cardiac surgery at the Cleveland Clinic. This formulation serves as the crystalloid component, which is delivered 4:1 with oxygenated patient’s blood to crystalloid. Meanwhile, our use of the del Nido cardioplegia solution in adult patients, heretofore primarily used in pediatric cardiac surgical centers, has been increasing over the past several years. Single-dose, cold blood del Nido cardioplegia can be delivered antegrade if the duration of the operation will be limited and if there is no significant coronary artery disease or aortic insufficiency that would limit the distribution of cardioplegia. The addition of del Nido cardioplegia to our cardioplegia armamentarium allows us to customize our myocardial protection strategies for different surgical needs. This article aims to provide information on technical aspects of del Nido cardioplegia in adult cardiac surgery and its use at the Cleveland Clinic in the adult surgical population.

Keywords: myocardial protection and cardioplegia, del Nido solution

Most adult cardiac surgeries are performed on the arrested heart. Cardiac arrest with cardioplegia provides a reproducible and safe method to induce and maintain electromechanical cardiac quiescence. The flaccid, noncontracting heart decreases the possibility of air embolism during open procedures performed on the left side of the heart and provides a still surgical field. Aortic cross-clamping eliminates continuous coronary blood flow to the myocardium thus providing a bloodless field, enhancing visibility. Cardioplegic arrest results in a significant reduction of energy consumption by the myocardial cells, even at normothermia (13). Under beating-heart circumstances, the myocardium requires a constant supply of oxygen to the myocardium to meet its high-energy consumption demands. Myocardial ischemia occurs when the supply of oxygen is exceeded by the demand and can lead to myocardial cell death (infarction) or injury, which can be exacerbated on reperfusion. The mechanisms of ischemia and reperfusion injury are complex. It is important to have an understanding of the components that contribute to this damage and to develop strategies to ameliorate these factors (25).

Although del Nido cardioplegia has been in use for decades in pediatric surgical centers, its use in adult surgical centers is a relatively new phenomenon. For instance, the team at New York Presbyterian Hospital (Columbia campus, New York, NY) has been using this type of cardioplegia exclusively in their adult cases for the past few years. Single-dose, cold blood del Nido cardioplegia can be delivered antegrade. Given the ease of its administration and its longer redosing interval, there is increasing interest in the adult cardiac community in the use of del Nido cardioplegia (68). Currently, there is no prospective data on its use in adults and few reports retrospective data have been available on this topic. In animal models, there is evidence that del Nido solution may provide superior myocardial protection in aged hearts (10,11). However, use of del Nido has primarily been limited to the pediatric arena. We became interested in its use in adult patients and began using it in this arena in 2012 and recently published our experience thus far in adult isolated valve operations (12). This article aims to provide information on the technical aspects of del Nido cardioplegia in adult cardiac surgery at the Cleveland Clinic from our experience thus far.

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