Comparison of Del Nido Cardioplegia and Blood Cardioplegia in Terms of Development of Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting

Sanrı, Umut Serhat; Özsin, Kadir Kaan; Toktaş, Faruk; Yavuz, Şenol

doi:10.21470/1678-9741-2020-0047

Umut Serhat Sanrı

MD

Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Kadir Kaan Özsin Correspondence Address: Kadir Kaan Özsin, https://orcid.org/0000-0001-5933-9322, Department of Cardiovascular Surgery. University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mahallesi, Emniyet Caddesi, Polis Okulu Karşısı, Yildirim, Bursa, Turkey, Zip code: 16320. E-mail: kkozsin@gmail.com

MD

Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

http://orcid.org/0000-0001-5933-9322

Faruk Toktaş

MD

Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Şenol Yavuz

MD

Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Correspondence Address: Kadir Kaan Özsin, https://orcid.org/0000-0001-5933-9322, Department of Cardiovascular Surgery. University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mahallesi, Emniyet Caddesi, Polis Okulu Karşısı, Yildirim, Bursa, Turkey, Zip code: 16320. E-mail: kkozsin@gmail.com

No conflict of interest.

Tables (6)

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Abbreviations, acronyms & symbols AF = Atrial fibrillation HT = Hypertension BC = Blood cardioplegia IABP = Intraaortic balloon pump CABG = Coronary artery bypass grafting ICU = Intensive care unit CI = Confidence interval OR = Odds ratio COPD = Chronic obstructive pulmonary disease PoAF = Postoperative atrial fibrillation CRP = C-reactive protein ROS = Reactive oxygen species CPB = Cardiopulmonary bypass SPSS = Statistical Package for the Social Sciences DNC = Del Nido cardioplegia STS = Society of Thoracic Surgeons ECG = Electrocardiography

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Table 1
Characteristics of cardioplegia.

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Table 2
Demographic characteristics and laboratory variables of the patients.

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Table 3
Operative and postoperative parameters.

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Table 4
Binary logistic regression analysis to identify predictors of PoAF.

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Authors' roles & responsibilities USS Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published KKO Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published FT Drafting the work or revising it critically for important intellectual content; final approval of the version to be published SY Drafting the work or revising it critically for important intellectual content; final approval of the version to be published

Abbreviations, acronyms & symbols
AF	= Atrial fibrillation	HT	= Hypertension
BC	= Blood cardioplegia	IABP	= Intraaortic balloon pump
CABG	= Coronary artery bypass grafting	ICU	= Intensive care unit
CI	= Confidence interval	OR	= Odds ratio
COPD	= Chronic obstructive pulmonary disease	PoAF	= Postoperative atrial fibrillation
CRP	= C-reactive protein	ROS	= Reactive oxygen species
CPB	= Cardiopulmonary bypass	SPSS	= Statistical Package for the Social Sciences
DNC	= Del Nido cardioplegia	STS	= Society of Thoracic Surgeons
ECG	= Electrocardiography

Components	Blood cardioplegia	Del Nido cardioplegia
Blood:Cardioplegia ratio	4:1	1:4
Base solution (mL)	Ringer Lactate (1000)	Isolyte-S (1000)
KCl (mEq)	16	26
8.4%, NaHCO₃ (mL)	10	13
20%, mannitol (mL)	0	17
2%, lidocaine (mL/mg)	0	6.5/130
15%, MgSO₄ (mL or g)	0	14/2

	BC (Group 1)	DNC (Group 2)	P-value
	(n=123)	(n=132)	P-value
Age (years)	60.78±9.96	61.67±10.16	0.483^* * Student's t-test;
Male gender, n (%)	91 (74)	106 (80.3)	0.229^# # Pearson chi-square test;
Hypertension, n (%)	72 (58.5)	68 (51.5)	0.260^# # Pearson chi-square test;
Diabetes mellitus, n (%)	59 (48)	48 (36.4)	0.061^# # Pearson chi-square test;
Ejection fraction (%)	50.5±9.03	49.1±9.82	0.289^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
BSA	1.85±0.17	1.84±0.17	0.641^* * Student's t-test;
Hematocrit (%)	40.0±5.77	40.3±4.48	0.646^* * Student's t-test;
White blood cell (103/µL)	8.9±2.5	8.87±2.77	0.596^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
Platelet (103/µL)	243.80±66.94	245.20±64.70	0.545^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
Creatinine (mg/dL)	0.93±0.32	0.94±0.24	0.123^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
Na (mEq/L)	138.24±2.96	138.49±2.80	0.363^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
K (mEq/L)	4.25±0.51	4.27±0.43	0.728^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
Ca (mg/dL)	9.13±0.5	9.26±0.48	0.063^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
Mg (mg/dL)	1.89±0.18	1.92±0.21	0.434^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
Free T3 (pg/mL)	2.91±0.45	2.92±0.65	0.798^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
Free T4 (ng/dL)	1.25±0.21	1.35±0.46	0.235^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
TSH (IU/mL)	2.73±4.27	1.86±1.51	0.092^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia
C-reactive protein (mg/dL)	8.54±11.93	9.77±19.90	0.967^¶ ¶ Mann-Whitney U test. BC=blood cardioplegia; BSA=body surface area; DNC=del Nido cardioplegia

	BC (Group 1)	DNC (Group 2)	P-value
	(n=123)	(n=132)
Number of anastomoses	3.32±0.91	3.67±0.92	0.005^¶ ¶ Mann-Whitney U test;
Cross-clamp time (minutes)	62.8±18.66	59.30±17.36	0.042^¶ ¶ Mann-Whitney U test;
Total CPB time (minutes)	90.01±24.25	95.16±23.48	0.086^* * Student's t test;
Cardioplegia volume (mL)	1697.56±264.71	1041.67±138.71	<0.001^¶ ¶ Mann-Whitney U test;
Inotropic drugs support, n (%)	17 (13.8)	14 (10.6)	0.232^# # Pearson chi-square test;
IABP support, n (%)	14 (11.4)	10 (7.6)	0.298^# # Pearson chi-square test;
PoAF, n (%)	44 (35.8)	32 (24.2)	0.044^# # Pearson chi-square test;
ICU stay (days)	3.08±3.31	3.06±3.9	0.520^¶ ¶ Mann-Whitney U test;
Hospital stay (days)	7.23±2.56	6.89±3.27	<0.001^¶ ¶ Mann-Whitney U test;
Troponin T, ng/L	225±33.14	218.29±36.68	0.127^* * Student's t test;
Total mortality, n (%)	7 (5.7)	7 (5.3)	0.892^# # Pearson chi-square test;
LCOS, n (%)	2 (1.6)	2 (1,5)	1.000^a a Fisher's exact test. BC=blood cardioplegia; CPB=cardiopulmonary bypass; DNC=del Nido cardioplegia; IABP=intraaortic baloon pump; ICU=intensive care unit; LCOS=low cardiac output syndrome; PoAF=postoperative atrial fibrillation
Stroke, n (%)	4 (3.3)	2 (1,5)	0.433^a a Fisher's exact test. BC=blood cardioplegia; CPB=cardiopulmonary bypass; DNC=del Nido cardioplegia; IABP=intraaortic baloon pump; ICU=intensive care unit; LCOS=low cardiac output syndrome; PoAF=postoperative atrial fibrillation
Respiratory cause, n (%)	1 (0.8)	3 (2.3)	0.338^a a Fisher's exact test. BC=blood cardioplegia; CPB=cardiopulmonary bypass; DNC=del Nido cardioplegia; IABP=intraaortic baloon pump; ICU=intensive care unit; LCOS=low cardiac output syndrome; PoAF=postoperative atrial fibrillation

Variables	Univariate analysis			Multivariate analysis
	P-value	Exp (B)	95% CI	P-value	Exp (B)	95% CI
		Odds ratio	Lower Upper		Odds ratio	Lower Upper
Age	0.062	1.026	0.999-1.055	0.207	1.019	0.990-1.048
HT	0.046	0.570	0.328-.991	0.301	0.734	0 .409-1.318
EF	0.417	0.988	0.961-1.017
CRP	0.793	1.003	0.983-1.023
Total CPB time	0.576	1.003	0.992-1.014
Cross-clamp time	0.400	1.006	0.992-1.021
Cardioplegia volume	0.048	1.001	1.000-1.001	0.033	1.001	1.000-1.001

Authors' roles & responsibilities
USS	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
KKO	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
FT	Drafting the work or revising it critically for important intellectual content; final approval of the version to be published
SY	Drafting the work or revising it critically for important intellectual content; final approval of the version to be published

[1] Correspondence Address: Kadir Kaan Özsin, https://orcid.org/0000-0001-5933-9322, Department of Cardiovascular Surgery. University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mahallesi, Emniyet Caddesi, Polis Okulu Karşısı, Yildirim, Bursa, Turkey, Zip code: 16320. E-mail: kkozsin@gmail.com

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Comparison of Del Nido Cardioplegia and Blood Cardioplegia in Terms of Development of Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting

Abstract

Objective:

Methods:

Results:

Conclusion: