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Published on: May 28, 2019
Traditional vs. modified Ringer lactate-based del Nido cardioplegia impacts on clinical outcomes in patients
Naser Kachoueian1, Salimeh Janghorban1, Farhad Gorjipour2
1Shahid Beheshti University of Medical Sciences, Tehran 1516745811, Iran.
Insights
Lactated Ringer's solution as a base for del Nido cardioplegia (LR DN) did not provide adequate myocardial protection compared to Plasma-Lyte A (PL DN) during coronary bypass grafting surgery. Standard del Nido cardioplegia is recommended for better patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Cardioplegia Solutions
Background:
- Myocardial protection during coronary bypass grafting (CABG) with cardiopulmonary bypass (CPB) is critical.
- The standard del Nido cardioplegia solution uses Plasma-Lyte A (PL), which is costly and difficult to procure in some regions.
- Alternative cardioplegia bases are being investigated to reduce costs and improve accessibility.
Purpose of the Study:
- To evaluate the efficacy of using lactated Ringer's solution as a base for del Nido cardioplegia (LR DN) compared to the standard Plasma-Lyte A base (PL DN).
- To determine if LR DN offers comparable myocardial protection to PL DN in adult patients undergoing CABG surgery.
Main Methods:
- A prospective, randomized, blinded study involving 109 adult patients (age 18-75, ejection fraction >35%) undergoing CABG with CPB.
- Patients were randomized to receive either LR DN or PL DN cardioplegia.
- Key outcome measures included serum cardiac troponin I (cTnI) levels, inotrope use, ejection fraction, arrhythmia rates, and lactate levels.
Main Results:
- No significant differences were observed in cardiopulmonary bypass times, cardiac enzymes, transfusion needs, or arterial blood gases between the LR DN and PL DN groups.
- Postoperative serum cTnI levels were significantly higher in the LR DN group compared to the PL DN group at ICU admission and 24 hours post-ICU.
- A higher percentage of patients in the LR DN group required intraoperative epinephrine administration (29.8% vs. 11.5%).
Conclusions:
- Standard del Nido cardioplegia with a Plasma-Lyte A base provides superior myocardial protection compared to a lactated Ringer's based del Nido cardioplegia in adult CABG patients.
- The study recommends the continued use of standard del Nido cardioplegia for optimal myocardial protection in this patient population.
- Lactated Ringer's solution is not a suitable substitute for Plasma-Lyte A in del Nido cardioplegia for CABG surgery.
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.
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