Experience in the Use of del Nido Cardioplegia in Ramathibodi Hospital

Background: del Nido cardioplegia is an extracellular, single-dose, non-calcium cardioplegic solution that has been increasing in popularity for the last decade. Plasma-Lyte A, the main base solution is not available in Thailand. We hypothesized that lactated Ringer solution can safely replace Plasma-Lyte A as the main carrier for del Nido cardioplegia. Objective: To report early results using lactated Ringer solution as a main carrier for del Nido cardioplegia. Material and Method: All patients undergoing cardiac surgery with del Nido cardioplegia between December 2016 and May 2017 were reviewed. Preoperative, intraoperative, and postoperative outcomes were collected and analyzed. Results: Mean age was 51.48+20.58 years, and 57.14% were male. Mean STS score was 3.01+3.10. Total cardioplegia use was 1,207.43+380.93 ml. Number of cardioplegia given was 1.66+0.72 times. Aortic cross clamp time and total bypass time were 108.51+48.60 mins and 145.63+55.63 mins, respectively. Ventricular fibrillation after aortic cross clamp removal occurred in four patients (11.43%). ICU stay and hospital stay were 1.94+1.15 days and 8.06+7.57 days, respectively. New onset of atrial fibrillation occurred in six patients (17.14%). Complications occurred in one patient (2.86%) (acute kidney injury). There was one case of mortality (2.86%) was observed. Conclusion: Lactated Ringer solution can be used safely to replace the crystalloid component of del Nido cardioplegia, Plasma-Lyte A, with an acceptable result.