Kachoueian Naser, Janghorban Salimeh, Gorjipour Farhad, Torkashvand Majid, Mahjoob Mohammad Parsa, Aslani Hossein, Mehrabanian Mohamadjavad, Gorjipour Fazel
Shahid Beheshti University of Medical Sciences, Tehran 1516745811, Iran.
Rajaie Cardiovascular, Medical and Research Center, Tehran 1995614331, Iran - Iranian Scientific Society of Extra-Corporeal Technology, Tehran 1995614331, Iran.
J Extra Corpor Technol. 2024 Dec;56(4):159-166. doi: 10.1051/ject/2024010. Epub 2024 Sep 20.
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.
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.
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).
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.
心脏停搏液心肌保护是在冠状动脉旁路移植术（CABG）体外循环（CPB）期间减轻心肌损伤的关键方法。由于成本高昂，Del Nido心脏停搏液的主要成分Plasma-Lyte A在伊朗难以获得。本研究的目的是探讨以乳酸林格氏液作为Del Nido溶液（LR DN）的基础用于CABG手术成年患者时，是否可作为替代Plasma-Lyte A的可行选择。
本前瞻性、随机、双盲研究针对年龄在18至75岁、射血分数（EF）>35%且接受CPB下CABG手术的患者进行。患者被随机分配至LR DN组（改良Del Nido心脏停搏液）和PL DN组（标准Del Nido心脏停搏液）。测量并比较LR DN组和PL DN组患者的血清心肌肌钙蛋白I（cTnI）水平、血管活性药物的类型和剂量、EF、夹闭解除后的心律失常发生率以及乳酸水平。
共招募109例患者。两组在体外循环时间、心肌酶、输血需求和动脉血气方面无统计学显著差异。研究患者无死亡病例。LR DN组患者入住重症监护病房（ICU）后及离开ICU 24小时后的术后血清cTnI水平显著高于PL DN组患者。此外，LR DN组在手术室需要使用肾上腺素的患者更多（29.8%对11.5%；与PL DN组相比，p：0.019）。
我们得出结论，在接受CPB下CABG手术的成年患者中，标准Del Nido心脏停搏液比基于乳酸林格氏液的Del Nido心脏停搏液提供更好的心肌保护。我们建议为接受CABG手术的患者使用以Plasma-Lyte A为基础的标准Del Nido心脏停搏液。
