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Comparison between three single-dose cardioplegic solutions in myocardial protection: Cardioplegia Trial - a
Kathize Betti Lira1,2, Renan Senandes Delvaux1, Felipe Abatti Spadini1,2
1Postgraduate Program in Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil.
Insights
Del Nido (DN) cardioplegia showed reduced early troponin release and fewer transfusions compared to Custodiol (HTK) and modified del Nido (MDN) solutions. All three cardioplegic strategies offered effective myocardial protection in adult cardiac surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia
Background:
- Myocardial protection is crucial in adult elective cardiac surgery.
- Comparing single-dose cardioplegic solutions like Custodiol (HTK), del Nido (DN), and modified del Nido (MDN) is essential for optimizing surgical outcomes.
Purpose of the Study:
- To compare the myocardial protection offered by HTK, DN, and MDN cardioplegic solutions.
- To evaluate biochemical markers and clinical outcomes following their administration in adult cardiac surgery.
Main Methods:
- A double-blind randomized controlled trial involving 99 adult patients undergoing elective cardiac surgery.
- Administration of single-dose HTK, DN, or MDN cardioplegic solutions.
- Measurement of high-sensitivity cardiac troponin T (hs-cTnT) and other clinical parameters postoperatively.
Main Results:
- All solutions provided effective myocardial protection with similar overall clinical outcomes.
- Del Nido (DN) solution was associated with significantly lower hs-cTnT levels at 2 hours and reduced intraoperative transfusions.
- Custodiol (HTK) group showed lower postoperative sodium and potassium levels, indicating transient electrolyte shifts.
Conclusions:
- The three cardioplegic strategies demonstrated comparable biochemical profiles regarding myocardial injury.
- DN solution may offer advantages in reducing early myocardial damage and transfusion needs.
- HTK solution can cause transient electrolyte disturbances.
Objectives:
To compare myocardial protection afforded by three single-dose cardioplegic solutions - Custodiol (HTK), del Nido (DN) and modified del Nido (MDN) - in adult elective cardiac surgery.
Design:
Double-blind randomised controlled trial.
Setting:
Tertiary hospital in southern Brazil.
Participants:
99 adults undergoing elective valve or coronary artery bypass surgery with cardiopulmonary bypass.
Interventions:
Administration of HTK, DN or MDN solution during surgery.
Main Outcome Measures:
High-sensitivity cardiac troponin T (hs-cTnT) at 0, 2, 12 and 24 hours postoperatively. Additionally, indirect measures of myocardial protection were compared, both laboratory and clinical, during intraoperative and postoperative periods.
Results:
All solutions provided effective myocardial protection, with similar clinical and laboratory outcomes. DN was associated with significantly lower hs-cTnT at 2 hours (p=0.023) and fewer intraoperative transfusions (p=0.008). HTK patients had lower postoperative sodium and potassium levels (p=0.049 and p=0.002, respectively). Survival and major postoperative outcomes, including vasoactive or mechanical support, were similar across groups.
Conclusions:
The three cardioplegic strategies showed comparable biochemical profiles of myocardial injury. DN was associated with lower early troponin release and reduced transfusion requirements, while HTK produced transient electrolyte shifts.
Trial Registration Number:
ReBEC; RBR-7g5s66.
