Student Research Committee of Shiraz University of Medical Sciences, PO BOX 71348-14336, Shiraz, Iran.
Heart Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, PO BOX 112412, United Arab Emirates.
J Extra Corpor Technol. 2024 Sep;56(3):84-93. doi: 10.1051/ject/2024011. Epub 2024 Sep 20.
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.
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 lactate-based 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.
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).
Normal saline, Ringer lactate, and plain Ringer provide comparable myocardial protection in adult-isolated 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.
Del Nido 心脏停搏液是一种广泛应用于各种情况下心肌保护的方法。然而，在成人心脏手术中，其有效性的证据有限，且基础溶液 Plasma Lyte A 并不容易获得，导致使用替代基础溶液。本研究旨在探讨常规 Del Nido 心脏停搏液在成人心脏手术中的有效性，以及不同基础溶液对心肌保护和其他围手术期结果的影响。
这是一项在伊朗一家三级保健医院进行的前瞻性、双盲、随机平行组临床试验。共评估了 187 名成人患者的入选资格，其中 120 名符合择期单纯 CABG 手术的纳入标准。患者被随机分为三组，每组 40 例。对照组接受基于生理盐水的常规 Del Nido 心脏停搏液，干预组 A 接受基于乳酸林格氏液的 Del Nido 心脏停搏液，干预组 B 接受基于普通林格氏液的 Del Nido 心脏停搏液。主要评估 Creatine Kinase-MB (CK-MB)、Troponin T、Troponin I 和乳酸的水平，分别在四个不同时间点：麻醉诱导后（基线）、2 小时、12 小时和 24 小时。
组间术前人口统计学和临床特征相同，无显著性差异（p>0.05）。基于 CK-MB、Troponin T、Troponin I 和乳酸水平，各组间无显著差异（p=0.078、0.143、0.311 和 0.129）。然而，Troponin T 和乳酸的时间效应有显著差异（p=0.034，p<0.001）。
在改良的 Del Nido 心脏停搏液成人孤立 CABG 手术中，生理盐水、乳酸林格氏液和普通林格氏液提供了相当的心肌保护。需要更大的研究来确定替代 Plasma Lyte A 的最佳方法，同时保持 Del Nido 心脏停搏液作为对照。
