90 B . Ali et al .: J Extra Corpor Technol 2024 , 56 , 84 – 93
Figure 2 . Trends in CK-MB , Troponin T , Troponin I , and lactate levels from baseline to 2 h , 12 h , and 24 h . The control group differs significantly from the rldNCS group ( p = 0.010 ).
the groups ; p = 0.484 ( Table 2 ). There were no reported deaths till patients were discharged in any of the groups . Additionally , there were no grass harms reported throughout the study .
Discussion
In recent years , there have been several studies conducted on del Nido cardioplegia and its effectiveness in adult cardiac surgery . However , none of them compared the modified version of del Nido cardioplegia vs other modified versions of del Nido cardioplegia for myocardial protection , which makes this study the first one of its kind as far as we know . One comparative study by Buel , et al .[ 22 ] found that del Nido cardioplegia had a six-fold decrease in post-cross-clamp off defibrillation compared to St . Thomas cardioplegia . Another study by Salinas et al . [ 13 ] concluded that single-dose del Nido cardioplegia was an effective and economic cardioplegia option with good outcomes in coronary surgery . It was found that most patients had a spontaneous return of sinus rhythm and there was a trend towards decreased transfusion rates . A clinical trial conducted by Niv Ad and his team in 2018 [ 23 ] compared whole-blood cardioplegia with del Nido cardioplegia and found that the del Nido could simplify surgical workflow while still being safe and producing similar clinical outcomes and suggested further research to clarify the trend for troponin , which could indicate better heart protection with del Nido solution . In 2019 , Kantathut et al . [ 14 ] conducted an observational study comparing the efficacy of lactated Ringer ’ s solution as a base for del Nido cardioplegia vs a standard blood cardioplegia strategy . The results indicated that traditional del Nido cardioplegia ingredients added to lactated Ringer ’ s provided myocardial protection that was either similar or superior to that of the blood cardioplegia strategy . This suggests that the lactated Ringer solution can be an option for centers that lack access to Plasma-Lyte and should be further investigated .
More recently , several other studies have been conducted to compare different variations of del Nido cardioplegia . Mitsutaka et al . [ 16 ] found that normal saline-based modified dNCS can be substituted for the original dNCS solution and still preserve left ventricular function recovery after prolonged global ischemia in piglet models . Karaarslan et al . [ 15 ] found that modified del Nido cardioplegia was good in terms of spontaneous sinus rhythm return along with less epicardial edema in their study groups . Tan et al . [ 17 ] conducted a meta-analysis study that included 18 Randomized Clinical Trials ( RCTs ) and 49 observational cohort studies involving 18,191 adult patients and 1634 children . Their findings suggested that del Nido cardioplegia may be associated with lower perioperative mortality than Custodial or Blood Cardioplegia among adult patients undergoing cardiac surgery . However , the risk of atrial fibrillation may be lower with Custodial than with Blood Cardioplegia or del Nido cardioplegia .
Finally , Sevuk et al . [ 24 ] compared adult patients undergoing cardiac surgical procedures using tepid normal saline-based modified del Nido cardioplegia vs cold blood cardioplegia patients and found that there was no significant difference between tepid normal saline-based modified del Nido cardioplegia and blood cardioplegia based on intraoperative defibrillation and postoperative peak Troponin T levels . However , mean cross-clamping time , CPB time and total operation time were significantly shorter in the del Nido group . Additionally , Amac