OBJECTIVES Few data exist on the use of del Nido cardioplegia in adults, specifically during operations requiring prolonged aortic cross-clamp. In this pilot study, we evaluate outcomes of patients undergoing surgery with cross-clamp time >3 h based on re-dosing strategy, using either full dose (FD; 1:4 blood to crystalloid ratio) or dilute (4:1 blood to crystalloid ratio) solution. METHODS Consecutive adult patients (>18 years) undergoing cardiac surgery from 2012 to 2018 with cross-clamp time >3 h were reviewed. Patients were excluded if del Nido cardioplegia was not used. Patients were categorized into FD or dilute groups based on re-dosing solution. Propensity score matching was used to control for baseline differences between groups. The primary endpoint was in-hospital mortality. Other outcomes examined included: postoperative mechanical support, arrhythmia, stroke, dialysis and cardiac function. RESULTS Included for analysis were 173 patients (115 male) with median age of 63.8 (interquartile range 53.9–73.1). Major comorbidities included diabetes (45), cerebrovascular disease (34), hypertension (131), atrial fibrillation (52) and previous cardiac surgery (83). There were 108 patients (62%) who received FD re-dosing, while 65 (38%) received dilute. A greater proportion of patients in the dilute group received retrograde delivery, for both induction (32/108 vs 39/65, P < 0.001) and re-dose (50/108 vs 53/65, P < 0.001). After propensity score matching, in-hospital mortality was not different between groups (6/48 vs 1/48, P = 0.131). There were no differences in rates of postoperative mechanical circulatory support, stroke, left ventricular ejection fraction or right ventricle dysfunction. CONCLUSIONS Del Nido cardioplegia has been used in complex cardiac surgery requiring prolonged cross-clamp. Re-dosing can be performed with either FD or dilute del Nido solution with no statistical difference in outcomes.

中文翻译：

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在需要延长主动脉交叉钳夹的成人心脏手术中重新给药 del Nido 心脏停搏液

目标 很少有关于成人使用 del Nido 心脏停搏的数据，特别是在需要长时间主动脉交叉钳夹的手术期间。在这项初步研究中，我们根据重新给药策略，使用全剂量（FD；1:4 血液与晶体液比）或稀释（4:1 血液晶体比）溶液。方法 回顾 2012 年至 2018 年连续接受心脏手术且交叉钳夹时间＞3 小时的成年患者（＞18 岁）。如果不使用 del Nido 心脏停搏，则排除患者。根据重新给药溶液将患者分为 FD 组或稀释组。倾向得分匹配用于控制组间的基线差异。主要终点是住院死亡率。检查的其他结果包括：术后机械支持、心律失常、中风、透析和心功能。结果 纳入分析的有 173 名患者（115 名男性），中位年龄为 63.8 岁（四分位距为 53.9-73.1）。主要合并症包括糖尿病 (45)、脑血管疾病 (34)、高血压 (131)、心房颤动 (52) 和既往心脏手术 (83)。有 108 名患者 (62%) 接受了 FD 重新给药，而 65 名 (38%) 接受了稀释。对于诱导（32/108 对 39/65，P < 0.001）和重新给药（50/108 对 53/65，P < 0.001），稀释组中更大比例的患者接受了逆行分娩。倾向评分匹配后，两组的住院死亡率无差异（6/48 vs 1/48，P = 0.131）。术后机械循环支持、卒中、左心室射血分数或右心室功能障碍。结论 Del Nido 心脏停搏液已用于需要长时间交叉钳夹的复杂心脏手术。可以使用 FD 或稀释的 del Nido 溶液重新给药，结果没有统计学差异。