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• W3117292472 abstract "Central MessageUse of terminal normothermic whole blood cardioplegia promotes recovery of left ventricular contractility and compliance after prolonged single-dose Del Nido cardioplegic arrest.See Article page e143. Use of terminal normothermic whole blood cardioplegia promotes recovery of left ventricular contractility and compliance after prolonged single-dose Del Nido cardioplegic arrest. See Article page e143. In this issue of the Journal, Nakao and colleagues1Nakao M. Kiyozo M. Shinohara G. Saito S. Kunihara T. Superior restoration of left ventricular performance after prolonged single-dose del Nido cardioplegia in conjunction with terminal warm blood cardioplegic reperfusion.J Thorac Cardiovasc Surg. 2022; 164: e143-e153Abstract Full Text Full Text PDF Scopus (5) Google Scholar use a piglet model of cardiopulmonary bypass with Del Nido cardioplegic arrest to demonstrate enhanced early recovery of left ventricular function with administration of a dose of terminal warm blood cardioplegia (TWBCP, aka a “hot shot”). The physiologic effects of the combination of prolonged Del Nido cardioplegia followed by TWBCP have not been characterized in an experimental model previously. Designed to facilitate pediatric surgeries, Del Nido cardioplegia use in adult cardiac surgery is not commonly used. The use of Del Nido cardioplegia in adult patients has been limited by concerns about increased arrhythmias, decreased contractility, and decreased glycogen stores outweighing the potential benefits of uninterrupted flow of the surgical procedure.2An K.R. Rahman I.A. Tam D.Y. Ad N. Verma S. Fremes S.E. et al.A systematic review and meta-analysis of Del Nido versus conventional cardioplegia in adult cardiac surgery.Innovations (Phila). 2019; 14: 385-393Crossref PubMed Scopus (27) Google Scholar However, if capable of comparable outcomes in the adult population, single-dose del Nido cardioplegia strategy facilitates minimally invasive approaches and reduces ischemic times in the adult cardiac surgery patients. The present study offers insights into improving cardioplegia strategies for specific patient populations. In a well-designed piglet model of cardiopulmonary bypass, the authors assessed myocardial function and cellular damage after administration of a dose of TWBCP after 120 minutes of Del Nido cardioplegic arrest. They demonstrated enhanced recovery of contractility as assessed by measurement of end-systolic elasticity and improved compliance. Quantification of glycogen granules was done using electron microscopy, and the authors found that glycogen granules were restored in TWBCP-treated animals. Whether this points to the actual mechanism of the beneficial effects of TWBCP on recovery of left ventricular function is unclear. The study raises both pragmatic and physiologic questions related to cardioplegia. One of the primary benefits of a single shot of Del Nido cardioplegia is the prospect of improved surgical flow. Yet, in the few randomized controlled trials of Del Nido cardioplegia compared with cold blood cardioplegia in adult cardiac surgery patients, the outcomes were quite similar.3Sanetra K. Gerber W. Shrestha R. Domaradzki W. Krzych Ł. Zembala M. et al.The del Nido versus cold blood cardioplegia in aortic valve replacement: a randomized trial.J Thorac Cardiovasc Surg. 2020; 159: 2275-2283.e1Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar,4Ad N. Holmes S.D. Massimiano P.S. Rongione A.J. Fornaresio L.M. Fitzgerald D. The use of del Nido cardioplegia in adult cardiac surgery: a prospective randomized trial.J Thorac Cardiovasc Surg. 2018; 155: 1011-1018Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar Importantly, the authors of the current study and in previous work demonstrate impaired left ventricular function after prolonged, single-dose Del Nido cardioplegic arrest. While this is ameliorated with TWBCP before release of the aortic crossclamp, this raises the question of whether Del Nido solution is an improvement on cold blood cardioplegia strategies. It remains unclear how TWBCP restores ventricular function in the early phase of reperfusion. Whether a Del Nido cardioplegia strategy with TWBCP is superior to cold blood cardioplegia can only be answered with a randomized controlled trial in adult human patients. Nonetheless, single-center studies from programs that currently use Del Nido cardioplegia might be informative. The mechanism of TWBCP is approached in the current study but questions remain. Can glycolysis occur in a matter of minutes? Is this the actual mechanism by which left ventricular function is restored? These questions could be addressed in further studies in animal models, preferably using an adult pig as opposed to a piglet model. Translational studies in an adult swine model may lead to improvements in single-dose cardioplegia that preserve the benefits of that strategy. Superior restoration of left ventricular performance after prolonged single-dose del Nido cardioplegia in conjunction with terminal warm blood cardioplegic reperfusionThe Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 4PreviewAn incomplete restoration of left ventricular contractility after del Nido cardioplegia was noted in our recent study. This study tested the hypothesis that terminal warm blood cardioplegia promotes a prompt restoration of left ventricular performance after a prolonged single-dose del Nido cardioplegia. Full-Text PDF" @default.
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• W3117292472 date "2022-10-01" @default.
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• W3117292472 title "Commentary: Del Nido cardioplegia with a “hot shot”" @default.
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