Antegrade Versus Continuous Retrograde del Nido Cardioplegia in the David I Operation

Background The efficacy of continuous retrograde del Nido cardioplegia for myocardial protection is still controversial. We hypothesised that antegrade and retrograde cardioplegia offer equivalent safety for myocardial protection in the David I procedure. Methods We retrospectively reviewed 33 patients undergoing the David I operation with antegrade or retrograde del Nido solution from June 2014 to January 2016. The outcomes were compared. The follow-up was 1 month to 15 months. Results There was no hospital mortality or reoperation in both groups. Cardiopulmonary bypass, and aortic clamp times were similar. Troponin I level (TnI), creatine kinase level (CKMB), left ventricular ejection fraction (LVEF), ventilation times, intensive care unit (ICULOS) and hospital stay times (THLOS) were similar between the two groups. The lactate level was slightly higher (9.26 ± 2.56 vs 7.17 ± 1.58, p  = 0.01) in the antegrade group compared with the retrograde group. The incidence of heart block was higher (four patients) in the retrograde group (26.7% vs 0%, p  = 0.019). Only one patient (6.7%) required implantation of a permanent cardiac pacemaker. Conclusion Antegrade and continuous retrograde del Nido cardioplegia can be used safely and effectively in the David I operation. The continuous retrograde del Nido cardioplegia is associated with a higher rate of temporary AV block which does not require permanent pacing, and a lower lactate level.