The Journal of ExtraCorporeal Technology No 56-4 | Page 25

N . Kachoueian et al .: J Extra Corpor Technol 2024 , 56 , 159 – 166 163

Table

2 . Frequency distribution of demographic and basal variables among patients of LR DN ( modified del Nido ) and PL DN groups ( conventional del Nido solution ).

BMI : body mass index , BSA : body surface area , CPB : cardiopulmonary bypass , ICU : intensive care unit , IQR : interquartile range . The p value was calculated by the student ’ s t-test for data with normal distribution . Frequencies between groups were compared with the Chi-squares test .

Figure 2 . Between-group comparison of the lactate dehydrogenase ( LDH ) and CPK-MB demonstrated significant differences between two groups at post-operative time . The post-operative value was significantly higher in the Trial group receiving modified del Nido solution based on lactated Ringer ’ s solution ( LR DL ) compared with the standard del Nido solution based on Plasma-Lyte A ( PL DL ). Presented p-values were calculated using analysis of covariance ( ANCOVA ) with Bonferroni adjustment with values for the baseline ( preoperative ) amounts of LDH ( A ) and CPK-MB ( B ) set as covariates to adjust for the differences in the baseline between two groups . # p < 0.05 vs . the PL DN group at the same time , & p < 0.05 vs . the baseline ( preop ) in the same group , ** p < 0.001 compared with the baseline in the same group .

the modified DN solution based on Ringer ’ s lactate with the conventional DN solution based on Plasma-Lyte A .

Another study by Talwar et al . compared the standard DN solution with the modified DN solution as cardioplegia in patients under 12 years of age undergoing CPB for surgical correction of tetralogy of Fallot [ 14 ]. Their results demonstrated the non-inferiority of the Ringer ’ s lactate-based del Nido cardioplegia compared to the standard formula . This finding contradicts the results of the current study , which showed the superiority of the standard DN solution compared to the modified DN solution . The differences in findings may be attributed to variations in patient age and corresponding anthropometric characteristics . Adult patients generally have higher body weights , necessitating larger volumes of cardioplegia , which may influence outcomes differently . Additionally , the surgical approaches , cardiac pathologies , and metabolic demand are different in adults compared to children .

It should be noted that Ringer ’ s lactate solution contains calcium whereas Plasma-Lyte A does not . Intracellular calcium management may therefore be impacted by the higher calcium content of the Ringer ’ s lactate-based cardioplegia vs . the standard formula .

Kantahut et al . studied the use of LR solution as a base for DN cardioplegia , and reported no differences in clinical and laboratory findings [ 15 ]. Their patients were from different cardiac surgery types such as isolated CABG , valve replacement and repair and mixed operations . Our findings are in agreement with Kantahut et al . in terms of clinical outcomes and laboratory findings except for cTnI and epinephrine administration in the operation room . In the LR DN group , cTnI levels were higher after operation and persisted until the 24 h postoperation . This finding is very important and contradicts the findings of Kantahut et al . Since our study population is homogeneous and in isolated CABG patients , the differences could be attributed to the differences in the operation types of patients . Also , we found that epinephrine administration in the operation room after CPB is significantly higher in the LR group which is consistent with the laboratory findings regarding myocardial damage .

While caution is necessary in generalizing the findings of the current study , they do raise concerns about replacing Plasma-Lyte A with Ringer ’ s lactate in the DN solution during cardiac operations in adults under CPB . Further investigations are needed to fully understand the implications of these findings .