B . Ali et al .: J Extra Corpor Technol 2024 , 56 , 84 – 93 91
Table 3 . Intraoperative and postoperative clinical characteristics .
|
Control group ( rdNC ) |
Group A ( rldNCS ) |
Group B ( prdNCS ) |
p-value |
|
n = 40 |
n = 40 |
n = 40 |
|
Bypass time ( min ) |
68.5 ( 60 – 80 ) |
68.5 ( 60 – 86.75 ) |
70 ( 65 – 75.75 ) |
0.824 |
Clamp time ( min ) |
42.5 ( 35.75 – 47.75 ) |
41.5 ( 38.25 – 54.75 ) |
44.5 ( 38 – 49.25 ) |
0.796 |
Post clamp off VF . DC |
14 ( 35 ) |
11 ( 27.3 ) |
12 ( 30 ) |
0.761 |
Total grafts |
4 ( 3.25 – 4 ) |
4 ( 4 – 4 ) |
4 ( 3 – 4 ) |
0.536 |
CK-MB ( UL �1 ) Baseline |
12.22 ± 7.26 |
10.35 ± 7.18 |
12.82 ± 6.71 |
Time = 0.344 |
2 h |
13.22 ± 7.09 |
11.52 ± 7.17 |
15.30 ± 7.10 |
Time Gp = 0.787 |
12 h |
12.05 ± 7.27 |
11.81 ± 7.29 |
12.90 ± 7.59 |
Group = 0.078 |
24 h |
12.61 ± 6.83 |
11.86 ± 7.32 |
12.37 ± 7.03 |
|
Trop T ( ngmL �1 ) Baseline |
0.106 ± 0.055 |
0.108 ± 0.060 |
0.105 ± 0.063 |
Time = 0.034 * |
2 h |
0.128 ± 0.067 |
0.132 ± 0.060 |
0.119 ± 0.063 |
Time Gp = 0.759 |
12 h |
0.115 ± 0.066 |
0.133 ± 0.074 |
0.130 ± 0.066 |
Group = 0.143 |
24 h |
0.107 ± 0.076 |
0.126 ± 0.077 |
0.095 ± 0.069 |
|
Trop I ( ngmL �1 ) Baseline |
0.016 ± 0.009 |
0.020 ± 0.016 |
0.012 ± 0.012 |
Time = 0.609 |
2 h |
0.015 ± 0.011 |
0.019 ± 0.015 |
0.014 ± 0.014 |
Time Gp = 0.444 |
12 h |
0.018 ± 0.009 |
0.020 ± 0.009 |
0.015 ± 0.014 |
Group = 0.311 |
24 h |
0.019 ± 0.010 |
0.017 ± 0.010 |
0.015 ± 0.015 |
|
Lactate ( mgdL �1 ) Baseline |
10.42 ± 5.10 |
11.73 ± 4.89 |
11.38 ± 4.95 |
Time = < 0.001 * |
2 h |
14.65 ± 6.11 |
14.03 ± 5.27 |
12.52 ± 4.60 |
Time Gp = 0.064 |
12 h |
15.54 ± 5.61 |
12.08 ± 5.07 |
13.30 ± 4.67 |
Group = 0.129 |
24 h |
12.11 ± 4.30 |
11.65 ± 4.07 |
11.15 ± 4.02 |
|
Post operative AFL |
2 ( 5 ) |
3 ( 7.5 ) |
4 ( 10 ) |
0.908 |
Post operative AF |
4 ( 10 ) |
5 ( 12.5 ) |
4 ( 10 ) |
> 0.999 |
Ventilation support ( h ) |
5.7 ( 4.5 – 6.5 ) |
5.5 ( 4.1 – 6.5 ) |
5.7 ( 4.5 – 7 ) |
0.580 |
ICU stay ( h ) |
64 ( 43.23 – 85.25 ) |
63.5 ( 40.50 – 75.75 ) |
52 ( 45.50 – 69.50 ) |
0.484 |
CK-MB ( Creatine Kinase-Myoglobin Binding ), Trop T ( Troponin T ), Trop I ( Troponin I ), VF . DC ( Ventricular Fibrillation needing Direct Current Cardioversion ), AFL ( Atrial Flutter ), AF ( Atrial Fibrillation ), ICU ( Intensive Care Unit ). * p < 0.05 .
et al . [ 9 ] conducted a review of articles regarding the use of single-dose Bretschneider cardioplegia and single-dose del Nido cardioplegia in adult cardiac surgery . Their findings showed that del Nido cardioplegia was a superior and safer technique for myocardial protection , resulting in reduced aortic cross-clamp duration , cardiopulmonary bypass time , and required cardioplegia solution volume . This technique also exhibited benefits for many organs and cardiac biochemical parameters .
Our study used a modified version of the del Nido cardioplegia solution as a control group in our setups , which showed no major complications in the past . However , our research found no significant differences in myocardial protection between using normal saline-based , Ringer lactate-based , or plain Ringer-based modified del Nido cardioplegia , alongside other intraoperative and postoperative factors .
Regardless of statistical significance , there were some differences observed , The levels of CK-MB were higher in the plain Ringer-based del Nido cardioplegia group , while Troponin T and Troponin I were higher in the Ringer lactate-based del Nido cardioplegia group , and lactate was higher in the normal saline-based group . Interestingly , the bypass time , clamp time , frequency of atrial flutter , and mechanical ventilation support were higher in the plain Ringer-based del Nido cardioplegia group . After clamping off , VF needing DC shock and ICU stay were higher in the normal saline-based del Nido cardioplegia group , and the frequency of atrial fibrillation was higher in the Ringer lactate-based group . However , since the primary outcome values for all groups were within the normal range , we cannot claim one solution is superior to the others based on these differences . Similarly , based on the various outcomes observed , we cannot confirm our hypothesis that Ringer lactate-based del Nido cardioplegia will prove to be more efficient than the other two groups , in terms of cardiac markers .
Therefore , we concluded that all three solutions , including normal saline , Ringer lactate , and plain Ringer , can serve as a baseline solution for modified del Nido cardioplegia if the Plasma Lyte A solution is unavailable .
Limitation
Our study had several limitations , but the major one was the use of normal saline as the baseline solution for routine del Nido cardioplegia and considering this modified version as a control in our study . Our results may not be generalizable to other countries with original cardioplegia . Additionally , our inclusion criteria only covered low-risk elective isolated CABG surgeries .