J Extra Corpor Technol 2024 , 56 , 159 – 166 Ó The Author ( s ), published by EDP Sciences , 2024 https :// doi . org / 10.1051 / ject / 2024010
Available online at : ject . edpsciences . org
ORIGINAL ARTICLE
Traditional vs . modified Ringer lactate-based del Nido cardioplegia impacts on clinical outcomes in patients undergoing coronary artery bypass grafting : Results from a prospective , randomized , blinded trial
Naser Kachoueian ( MD ) 1 , a , Salimeh Janghorban ( MD ) 1 , a , Farhad Gorjipour ( MSc ) 2 , 3 ,* , Majid Torkashvand ( MD ) 4 , Mohammad Parsa Mahjoob ( MD ) 1 , Hossein Aslani ( MD ) 4 , Mohamadjavad Mehrabanian ( MD ) 4 , and Fazel Gorjipour ( PhD ) 5 ,*
1 Shahid Beheshti University of Medical Sciences , Tehran 1516745811 , Iran 2 Rajaie Cardiovascular , Medical and Research Center , Tehran 1995614331 , Iran 3 Iranian Scientific Society of Extra-Corporeal Technology , Tehran 1995614331 , Iran 4 Tehran University Medical Sciences , Tehran 1416634793 , Iran 5 Physiology Research Center , Iran University of Medical Sciences , Tehran 1449614535 , Iran
Received 22 February 2024 , Accepted 13 May 2024
Abstract – Introduction : Myocardial protection with cardioplegia is a crucial approach to mitigate myocardial damage during coronary bypass grafting surgery ( CABG ) with cardiopulmonary bypass ( CPB ). The major component of the del Nido cardioplegia solution , Plasma-Lyte A , is difficult to obtain in Iran due to high cost . The objective of the current study was to study if the lactated Ringer ’ s solution as the base for del Nido solution ( LR DN ) usage is a viable option as a substitute for Plasma-Lyte A in adult patients presenting for CABG surgery . Study design and methods : The present prospective , randomized , blinded study was performed on 18 – 75-year-old patients ejection fraction ( EF ) > 35 % undergoing CABG with CPB . Patients were randomly allocated to LR DN ( modified del Nido cardioplegia ) and PL DN ( standard del Nido cardioplegia solution ) groups . Serum level of cardiac troponin I ( cTnI ), the type and dosage of inotrope agents , EF , rate of arrhythmia after clamp removal and lactate level were measured and compared between patients of LR DN and PL DN groups . Results : 109 patients were recruited . There were no statistically significant differences between groups for cardiopulmonary bypass times , cardiac enzymes , transfusion requirements , and arterial blood gases . There was no mortality for study patients . Postoperative serum levels of cTnI among patients in the LR DN group was significantly higher than patients of the PL DN group after ICU admission and 24 h post-ICU . Also , more patients needed epinephrine administration in the operating room in the LR DN group ( 29.8 % vs . 11.5 %; p : 0.019 vs . PL DN group ). Conclusion : We concluded that the standard del Nido cardioplegia solution offers better myocardial protection compared with Ringer ’ s lactate-based del Nido cardioplegia in adult patients undergoing CABG with CPB . We recommend using standard del Nido cardioplegia with a PL base for patients presenting for CABG surgery .
Key words : Cardioplegia solution , Coronary bypass grafting , Myocardial ischemia , del Nido , Adult cardiac surgery .
Introduction
Cardiac operations with cardiopulmonary bypass ( CPB ) have variable impacts on patients ’ intraoperative and postoperative physiological status , such as hemodynamic instability , hemorrhage , coagulative disorders , inflammatory factors release , oxidative factors production , edema , systemic inflammatory response syndrome , and organ failure [ 1 , 2 ]. Myocardial
a These authors contributed equally to this work .
* Corresponding authors : fgorjipour @ gmail . com ( F . Gorjipour ); gorjipoorf @ yahoo . com ( F . Gorjipour ); protection during ischemia and reperfusion is one of the main problems during cardiac surgery and the cardioplegia solution has a significant impact on preventing inflammatory responses , ischemia , and reperfusion [ 3 – 5 ].
For several decades , del Nido cardioplegia solutions have been used in both pediatric and adult cardiac operations . Cost-effectiveness , single-dose usage without the need for repeated dosing until 90 min , and shorter pump time are reported as del Nido benefits [ 6 – 10 ]. The time between initial and redosing can cause myocardial impairment due to the risk of myocardial warming and ischemia [ 11 ]. Moreover , Plasma- Lyte-A as the primary solution for del Nido cardioplegia is cost
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