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Modified Del Nido Versus Custodiol® Cardioplegia for Myocardial Protection in Adult Patients Undergoing Cardiac
Mahdy A Abdelhady1, Abeer S Goda1, Mohamed S Sayed Gomaa2
1Departments of Anesthesiology, Fayoum University, Fayoum, Egypt.
Insights
Modified Del Nido cardioplegia offers superior myocardial protection compared to Custodiol® in adult open-heart surgery. This study found lower Troponin I levels and reduced hospital stays with Modified Del Nido cardioplegia.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia Solutions
Background:
- Myocardial protection is critical during cardiac surgery.
- Modified Del Nido and Custodiol® are established cardioplegia solutions.
- Limited clinical trials directly compare these two solutions.
Purpose of the Study:
- To compare the efficacy of Modified Del Nido cardioplegia versus Custodiol® for myocardial protection.
- To evaluate clinical outcomes in adult patients undergoing open-heart surgery with these cardioplegia solutions.
Main Methods:
- Prospective, randomized, double-blinded clinical trial.
- Fifty-eight adult patients undergoing elective open-heart surgery were enrolled.
- Patients received either Modified Del Nido (MDN) or Custodiol® (C) cardioplegia; Troponin I was the primary outcome measure.
Main Results:
- The Modified Del Nido group showed significantly lower Troponin I levels 24 hours post-surgery compared to the Custodiol® group.
- The MDN group demonstrated better outcomes in cardiac arrest duration, ventricular fibrillation incidence, and need for inotropes.
- Reduced hospital length of stay, ICU length of stay, and faster mechanical ventilation weaning were observed in the MDN group.
Conclusions:
- Modified Del Nido cardioplegia provides safe and effective myocardial protection in adult cardiac surgery.
- It presents a favorable alternative to Custodiol® cardioplegia, with improved clinical outcomes.
Background:
Cardioplegia is essential for myocardial protection. Modified Del Nido and Custodiol® cardioplegia have been successfully used; however, a limited number of clinical trials compared both solutions. Our objective was to evaluate the effectiveness of Modified Del Nido cardioplegia against Custodiol® in protecting the myocardium in adult patients having open heart surgery.
Methods:
In this prospective randomized double-blinded clinical trial, fifty-eight adult patients registered for elective open heart surgery at Fayoum University hospitals, Fayoum, Egypt, between February 2022 and November 2023, have enrolled. Patients were randomized to receive either a Modified Del Nido cardioplegia solution (MDN group) (n = 29) or Custodiol® cardioplegia (C group) (n = 29). The primary outcome was Troponin I (µg/L) measured 24 h after surgery.
Results:
Both groups had comparable demographics. Troponin I was much lower in the MDN group (median = 2.9, IQR = 2.7-3.2) than in the C group (median = 3.6, IQR = 3.1-4.1) 24 h after surgery. Similarly, there were substantial differences in CK-MB between the two groups 24 h postoperatively. The MDN group had better results in terms of time taken for cardiac arrest, the incidence of ventricular fibrillation upon cross-removal, and the percentage of patients requiring inotropes. The MDN group shows notably reduced hospital length of stay (LOS), intensive care unit length of stay (ICU LOS), and weaning from mechanical ventilation times.
Conclusions:
Adult cardiac surgery may be performed safely and successfully using Modified Del Nido cardioplegia in comparison to Custodiol® cardioplegia.
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