LEFT VENTRICULAR EJECTION FRACTION IN THE EARLY POST-OPERATIVE PHASE: COMPARATIVE RESULTS OF CRYSTALLOID AND BLOOD-BASED CARDIOPLEGIA SOLUTIONS

Background and Objective: Cardioplegia solutions provide effective myocardial protection during on-pump cardiac surgery. Both cold crystalloid, such as Del Nido, and blood-based, such as Calafiore solutions are widely used. However, the impact of cardioplegia selection on early post-operative global systolic function has yet to be fully assessed. Therefore, this study aimed to investigate the outcome of left ventricular ejection fraction (LVEF) after different cardioplegia solutions in adult patients undergoing on- pump cardiac surgery. Methods: Adult patients undergoing on-pump cardiac surgery were included and divided into groups based on the selected cardioplegia, GROUP-1: Del Nido, GROUP-2: Calafiore. LVEF was assessed by echocardiographic evaluation before and after surgery, and the difference (delta) between these values was calculated. A multivariable linear regression was performed to estimate the effect of cardioplegia selection on the delta variation in LVEF (DLVEF). Results: This study included 212 patients, 28% female, median age of 70 years [IQR:63.0-74.0]. No significant differences in baseline characteristics were observed, except for peripheral vasculopathy (p=0.031). Additionally, the types of surgery performed were comparable between the two groups (p=0.909). Post-operative LVEF was 55% [IQR:51.0-60.0] in GROUP-1 and 57%[IQR:51.0-63.0] in GROUP-2(p=0.036), with a DLVEF of +1.01[-3.2-6.0] in GROUP-1 and -2.00 [IQR:-9.0-4.0] in GROUP-2(p<0.001). Multivariable regression analysis (R 2 = 0.48) showed an increase β +3.21 in DLVEF in patients receiving Del Nido cardioplegia (p=0.002). No difference in early mortality was found between the two groups. Conclusions: This study shows Del Nido cardioplegia to be associated with a potential better preservation of LVEF in the early post-operative phase.