J Extra Corpor Technol 2024 , 56 , 84 – 93 Ó The Author ( s ), published by EDP Sciences , 2024 https :// doi . org / 10.1051 / ject / 2024011
Available online at : ject . edpsciences . org
ORIGINAL ARTICLE
Comparison of routine del Nido cardioplegia vs two types of modified del Nido cardioplegias for myocardial protection among patients undergoing coronary artery bypass grafting ( CABG ) surgeries : A randomized double-blind clinical trial
Babar Ali 1 , Salman Pervaiz Butt 2 ,* , Mohammad Ghazi Nour 3 , Mohammad Bagher Khosravi 4 , Naeimehossadat Asmarian 4 , Ali Raza Shoul 5 , Arun Kumar 2 , Umer Darr 2 , and Gopal Bhatnagar 2
1 Student Research Committee of Shiraz University of Medical Sciences , PO BOX 71348-14336 , Shiraz , Iran 2 Heart Vascular and Thoracic Institute , Cleveland Clinic Abu Dhabi , PO BOX 112412 , United Arab Emirates 3 Department of Surgery , Section of Cardiac Surgery , Shiraz University of Medical Sciences , PO BOX 71348-14336 , Shiraz , Iran 4 Anesthesiology and Critical Care Research Center , Shiraz University of Medical Sciences , PO BOX 71348-14336 , Shiraz , Iran 5 Department of Perfusion , Division of Anesthesiology and Critical Care Research Center , Shiraz University of Medical Sciences ,
PO BOX 71348-14336 , Shiraz , Iran Received 30 January 2024 , Accepted 13 May 2024
Abstract – Background : The del Nido cardioplegia solution is a widely used method for myocardial protection in various settings . However , there is limited evidence of its effectiveness in adult cardiac surgery , and the baseline solution , Plasma Lyte A , is not readily available , leading to the use of alternative baseline solutions . This study aims to investigate the effectiveness of routine del Nido cardioplegia in adult cardiac surgery and the impact of different baseline solutions on myocardial protection and other perioperative outcomes . Methods : This study was a prospective , double-blind randomized parallel group clinical trial conducted at a single tertiary care hospital in Iran . A total of 187 adult patients were evaluated for eligibility , of which 120 met the inclusion criteria for elective isolated CABG surgery . The patients were randomly assigned to three groups , with each group consisting of 40 patients . The control group received a normal saline-based routine del Nido cardioplegia , Intervention Group A received Ringer lactatebased del Nido cardioplegia , and Intervention Group B received plain Ringer-based del Nido cardioplegia . The levels of Creatine Kinase-MB ( CK-MB ), Troponin T , Troponin I , and lactate were primarily assessed at four different times : after anesthesia induction ( Baseline ), 2 h , 12 h , and 24 h . Results : Preoperative demographic and clinical characteristics were the same among groups with insignificant differences ( p > 0.05 ). There was no significant difference among groups based on CK-MB , Troponin T , Troponin I , and lactate levels ( p = 0.078 , 0.143 , 0.311 , and 0.129 respectively ). However , there was a significant difference in the time effect of Troponin T and Lactate ( p = 0.034 , p = < 0.001 ). Conclusion : Normal saline , Ringer lactate , and plain Ringer provide comparable myocardial protection in adultisolated CABG surgery with modified del Nido cardioplegia . Larger studies are needed to identify the best alternative to Plasma Lyte A while maintaining del Nido cardioplegia as the control .
Key words : Myocardial protection , Modified del Nido cardioplegia solution , Coronary artery bypass grafting ( CABG ) surgery .
Introduction
In most cardiovascular surgical procedures , surgeons require a still and without blood flow heart to perform the procedure accurately and safely . To achieve this , the heart is stopped and bypassed for a specific period , depending on the type of surgery [ 1 ]. One such surgery , coronary artery bypass grafting ( CABG ), is performed frequently worldwide due to
* Corresponding author : buttsab9 @ hotmail . com the high prevalence of coronary artery disease ( CAD ) in both developed and underdeveloped countries and also requires a bloodless and static field in most cases [ 2 – 4 ]. During cardiac surgery , protecting the myocardium is crucial to prevent complications such as ischemic reperfusion injury , myocardial infarction , and low output syndrome [ 5 ]. Since the 1950s researchers worldwide have been working to develop the best approach for myocardial protection during surgery . Intracellular or extracellular cardioplegia in either blood or crystalloid solution has been used in many setups to protect the myocardium .
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