WITHDRAWN: Single-dose del Nido cardioplegia in minimally invasive aortic valve surgery

Abstract Background The del Nido cardioplegia (DC) procedure offers prolonged cardiac protection with single-dose administration and has proven safe in adult coronary artery bypass grafting (CABG) surgery. We set out to evaluate the efficacy of cardiac protection and clinical outcomes of DC versus standard blood cardioplegia (BC) in minimally invasive aortic valve surgery. Methods Between August 2011 and May 2016, 178 patients underwent minimally invasive aortic valve replacement (AVR) with BC (n = 101) or DC (n = 77). Mini-sternotomy or right mini-thoracotomy was performed to gain surgical access. Clinical patient characteristics and data were extracted from our local Society of Thoracic Surgeons (STS) database and the electronic medical record. Patients were propensity-matched for age, sex, body mass index (BMI), valve size and type, STS score, surgical access, preoperative serum creatinine level, diabetes, and chronic obstructive pulmonary disease (COPD), yielding 63 well-matched pairs. Results There was no difference in patient age, preoperative serum creatinine, BMI, diabetes, COPD, or STS score between the BC and DC groups before or after propensity matching. BC patients received both anterograde and retrograde cardioplegia in multiple doses, whereas DC was delivered almost entirely anterograde, with 95% (73 of 77) of patients receiving a single dose only. DC was associated with decreased mean cardiopulmonary bypass (CPB) time (108 ± 24 vs 135 ± 43 minutes; P  = .001), mean aortic cross-clamping time (80 ± 16 vs 102 ± 30 minutes; P  = .001), and mean maximal glucose level during CPB (165 ± 39 vs 202 ± 49 mg/dL; P  = .001), whereas mean troponin T level did not differ significantly between the DC and BC groups (0.3 ± 0.29 vs 0.44 ± 1.7 ng/mL; P  = .70). The mean preoperative ejection fraction did not change after AVR in either the BC group (64 ± 12% vs 61 ± 10%; P  = .09) or the DC group (58 ± 14% vs 57 ± 14%; P  = .40). Conclusions In minimally invasive AVR surgery, DC provided equivalent myocardial protection and clinical outcomes as BC while simplifying the cardioprotective regimen and reducing aortic cross-clamping time. DC was associated with lower CPB glucose levels and demonstrated the feasibility of single dose administration.