The Journal of ExtraCorporeal Technology No 56-3 | Page 17

92 B . Ali et al .: J Extra Corpor Technol 2024 , 56 , 84 – 93
Recommendation
Lactated Ringer ’ s solution should be avoided in patients with hypercalcemia , hypokalemia , kidney stones , or a history of metabolic acidosis . Compared to normal saline , it has a lower risk of causing metabolic acidosis due to its lactate content . However , Ringer ’ s solution may interact negatively with certain medications . Research suggests that intraoperative blood sugar levels increase significantly when Ringer ’ s lactate is used , especially when combined with dextrose . While Ringer ’ s lactate is considered superior to normal saline , some clinicians avoid it due to concerns that lactate contributes to hyperglycemia , particularly in diabetic surgical patients . However , lactate in Ringer ’ s lactate is generally only problematic for patients with liver dysfunction , especially in cases of liver failure .
We recommend a study with a larger sample size and more parameters for primary outcomes to find the best alternative for Plasma Lyte A by keeping the original del Nido cardioplegia as the control standard .
Conclusion
There were no significant differences in CK-MB , Troponin T , Troponin I , and Lactate levels between using normal salinebased , Ringer lactate-based , or plain Ringer-based modified del Nido cardioplegia , along with other intraoperative and postoperative factors including ; bypass time , clamp time , cardioplegia volume , cardioplegia doses , post clamp removal VF , AFL , AF , Ventilation support time , ICU stay and mortality . 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 in isolated CABG surgery as there was no difference in myocardial protection among them .
Acknowledgements
We express our gratitude to the Department of Anesthesiology and Critical Care Research Center of the Shiraz University of Medical Science , Shiraz , Iran for their invaluable legal assistance . We extend our thanks to the perfusion department of Shahid Faghihi Hospital , Shiraz for their exceptional support during the intervention and follow-up period . Additionally , we appreciate the efforts of the clinical laboratory and ICU staff for providing us with the necessary data .
Funding
This project was funded by the Research Committee of Shiraz University of Medical Sciences ( Grant No : 1401-26912 ).
Conflicts of interest The authors declare no conflict of interest .
Data availability statement The research data is available on request from the authors .
Author contribution statement
Babar Ali : Lead conceptualization , Lead visualization , Lead writing original draft , Lead methodology .
Salman Pervaiz Butt : Lead supervision , Lead validation , Equal writing original draft and revision , Equal project administration , supporting data analysis .
Mohammad Ghazi Nour : Lead data curation , Lead project administration .
Mohammad Bagher Khosravi : Supporting visualization , Supporting project administration . Naeimehossadat Asmarian : Lead data analysis . Ali Raza Shoul : Equal data curation . Arun Kumar : Supporting supervision . Umer Darr : Supporting supervision . Gopal Bhatnagar : Supporting supervision .
Ethics approval
This study was approved by the Research Ethical Committee of the School of Medicine – Shiraz University of Medical Science ( Id : IR . SUMS . MED . REC . 1401.534 ) and was registered in the Iranian Registry of Clinical Trials ( Code : IRCT20230719058845N1 ). References
1 . Mertes PM , Kindo M , Amour J , et al . Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump . Anaesth Crit Care Pain Med . 2022 ; 41 ( 3 ): 101059 .
2 . Reichert HA , Rath TE . Cardiac surgery in developing countries . J Extra Corpor Technol . 2017 ; 49 ( 2 ): 98 – 106 .
3 . Roser M , Ritchie H , Spooner F , et al . Burden of Disease . Our World Data ; 2024 . Available at : https :// ourworldindata . org / burden-of-disease . Accessed March 31 , 2024 .
4 . Khan MA , Hashim MJ , Mustafa H , et al . Global epidemiology of ischemic heart disease : Results from the global burden of disease study . Cureus . 2020 ; 12 ( 7 ): e9349 .
5 . Vaage J , Valen G . Pathophysiology and mediators of ischemiareperfusion injury with special reference to cardiac surgery : A review . Scand J Thorac Cardiovasc Surg . 1993 ; 27 ( sup41 ): 1 – 18 .
6 . Yamamoto H , Yamamoto F . Myocardial protection in cardiac surgery : A historical review from the beginning to the current topics . Gen Thorac Cardiovasc Surg . 2013 ; 61 ( 9 ): 485 – 496 .
7 . Matte GS , Del Nido PJ . History and use of del Nido cardioplegia solution at Boston Children ’ s Hospital . J Extra Corpor Technol . 2012 ; 44 ( 3 ): 98 – 103 .
8 . Sanetra K , Pawlak I , Cisowski M . Del Nido cardioplegia – what is the current evidence ? Kardiochirurgia i torakochirurgia Pol = Polish J cardio-thoracic Surg . 2018 ; 15 ( 2 ): 114 – 118 .
9 . Amaç B , Selçuk M , Bölükbasß S , et al . Use of del Nido cardioplegia in adult cardiac surgery . Eur Res J . 2022 ; 8 ( 1 ): 139 – 144 .
10 . Miceli A , Murzi M , Gilmanov D , et al . Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy . J Thorac Cardiovasc Surg . 2014 ; 148 ( 1 ): 133 – 137 .
11 . Misfeld M , Davierwala P . Crystalloid-based cardioplegia for minimally invasive cardiac surgery . Semin Thorac Cardiovasc Surg . 2012 ; 24 ( 4 ): 305 – 307 .
12 . Mick SL , Robich MP , Houghtaling PL , et al . Del Nido versus Buckberg cardioplegia in adult isolated valve surgery . J Thorac Cardiovasc Surg . 2015 ; 149 ( 2 ): 626 – 636 . e5 .
13 . Guajardo Salinas GE , Nutt R , Rodriguez-Araujo G . Del Nido cardioplegia in low risk adults undergoing first time coronary artery bypass surgery . Perfusion . 2017 ; 32 ( 1 ): 68 – 73 .