Related Links
Statistics
| Number of Journals | 8 |
| Number of Issues | 55 |
| Number of Articles | 403 |
| Article View | 143,988 |
| PDF Download | 99,287 |
Comparison of cold and tepid modified delnido cardioplegia on myocardial protection in open heart surgery patients | ||
| Cardiovascular Biomedicine | ||
| Article 2, Volume 4, Issue 2, December 2024, Pages 4-13 PDF (545.6 K) | ||
| Document Type: original articles | ||
| DOI: 10.18502/cbj.v4i2.17789 | ||
| Authors | ||
| Saeed Rostamani1; Mehdi Hadadzadeh* 2; Seyed Hossein Moshtaghion2; Farimah Shamsi3; Ahmad Tajamolian2 | ||
| 1Department of Cardiovascular Research Center, School of Medicine, University of Medical Sciences, Yazd, Iran | ||
| 2Yazd Cardiovascular Research Center, Non- communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran | ||
| 3Biostatistics center for healthcare data modeling, Shahid Sadoughi university of medical sciences, Yazd, Iran | ||
| Abstract | ||
| Objectives: Cardioplegia is a crucial component of myocardial protection during aortic cross-clamping and cardiopulmonary bypass. It has been reported to provide effective myocardial protection and improved clinical outcomes with enhanced surgical flow in adult cardiac procedures. This study investigates the efficacy and safety of cold-modified Del Nido cardioplegia versus tepid blood cardioplegia in adult cardiac surgery patients using Myotherm, a device mainly used in cardiac surgery to monitor and manage the myocardial temperature during surgery. Methods: After obtaining approval from the ethics committee and establishing entry criteria that included age, type of heart surgery, and absence of cardioplegic contraindications, the researchers defined exclusion criteria- such as previous heart surgery or significant comorbidities. Seventy patients were randomly divided into two groups: Group A received a cold solution at 4°C ( n=35), while Group B received a tepid solution at 28°C (n=35). The amount of cardioplegia was 10 to 15 cc/kg and was injected with a pressure of 70 to 90 mm Hg in an anterograde manner. The temperature of cardioplegia was also adjusted with a Myotherm device. The day before the surgery, a written consent form was obtained from the patients, and the patients were informed about the study method. The sampling method is a double-blind clinical trial to achieve minimal bias, ensuring the reliability of the results and reducing influences on it. This study was conducted in Afshar Hospital in Yazd during 2023 and 2024. Results: There were no significant differences between the two groups in terms of the need for an intra-aortic balloon pump (p=1.0), intraoperative and postoperative inotropic support (p=0.26), and postoperative pacemaker(p=0.49). Also, there were no significant differences between the two groups in terms of troponin I level after surgery (p=0.50), left ventricular ejection fraction after discharge (p=0.34), time to return of spontaneous heart rhythm (P=0.25), cross-clamp time(P=0.30), cardiopulmonary bypass time (P=0.07), and length of stay in the ICU (P=0.21). Conclusions: The result showed that both techniques provide similar results. Although the time of cross-clamp and cardiopulmonary bypass was shorter in the group using tepid solution, these differences were not statistically significant. In other words, cold and tepid solutions are equally effective and safe to protect the myocardium, and doctors can use both types of solutions during open heart surgery. | ||
| Keywords | ||
| Myocardial protection; CPB; Cold and Tepid Modified Del Nido cardioplegia; Myotherm | ||
| References | ||
|
1.Matte GS, del Nido PJ. History and use of del Nido cardioplegia solution at Boston children's hospital. J Extra Corpor Technol. 2012;44(3):98-103.
2.Nakao M, Morita K, Shinohara G, et al. Excellent restoration of left ventricular compliance after prolonged Del Nido single-dose cardioplegia in an In vivo Piglet model. Semin Thorac Cardiovasc Surg. 2020;32(3):475-483.
3.Ad N, Holmes SD, Massimiano PS, et al. The use of del Nido cardioplegia in adult cardiac surgery: a prospective randomized trial. J Thorac Cardiovasc Surg.2018;155 (3):1011-1018.
4.Sanetra K, Gerber W, Shrestha R, et al. The del Nido versus cold blood cardioplegia in aortic valve replacement: a randomized trial. J Thorac Cardiovasc Surg.2020;159(6): 2275-2283.e1.
5.Lenoir M, Bouhout I, Jelassi A, et al. Del Nido cardioplegia versus blood cardioplegia in adult aortic root surgery. J Thorac Cardiovasc Surg. 2021;162(2):514-522.e2.
6.Kavala AA, Turkyilmaz S. Comparison of del Nido cardioplegia with blood cardioplegia in coronary artery bypass grafting combined with mitral valve replacement. Braz J Cardiovasc Surg. 2018;33(5):496-504.
7.Pragliola C, Hassan E, Ismail H, et al. del Nido cardioplegia in adult patients: a propensity-matched study of 102 consecutive patients. Heart Lung Circ.2020;29 (9):1405-1411.
8.Yammine M, Neely RC, Loberman D, et al. The use of lidocaine containing cardioplegia in surgery for adult acquired heart disease. J Card Surg. 2015;30(9):677-84.
9.James TM, Stamou SC, Faber C, et al. Whole Blood del Nido versus Cold Blood Microplegia in Adult Cardiac Surgery: A Propensity-Matched Analysis. Int J Angiol. 2019;33(1):29-35.
10.Stamou SC, Lopez C, Novello C, et al. Modified whole blood microplegia in high-risk patients. J Card Surg. 2019;34(3):118-123.
11.Kantathut N, Cherntanomwong P, Khajarern S, et al. Lactated ringer's as a base solution for del Nido cardioplegia. J Extra Corpor Technol. 2019;51(3):153-159.
12.Gallo M, Trivedi JR, Slaughter MS. Myocardial protection with complementary dose of modified Del Nido cardioplegia during heart transplantation. J Card Surg. 2019;34(11):1387-1389.
13.Vinten-Johansen J. Whole blood cardioplegia: do we still need to dilute? J Extra Corpor Technol. 2016;48(2):P9-P14.
14.Yamamoto H, Yamamoto F. Myocardial protection in cardiac surgery: a historical review from the beginning to the current topics. Gen Thorac Cardiovasc Surg.2013;61 (9):485-96.
15.Minatoya K, Okabayashi H, Shimada I, et al. Intermittent antegrade warm blood cardioplegia for CABG: extended interval of cardioplegia. Ann Thorac Surg.2000;69 (1):74-6.
16.Ghazy T, Allham O, Ouda A, et al. Is repeated administration of blood-cardioplegia really necessary? Interact Cardiovasc Thorac Surg. 2009;8(5):517-21.
17.Allham O, Ghazy T, Ouda A, et al. Intermittent antegrade warm blood cardioplegia, interval extended. J Thorac Cardiovasc Surg.2010;58(S 01):P51.
18.Hayashida N, Ikonomidis JS, Weisel RD, et al.The optimal cardioplegic temperature. Ann Thorac Surg. 1994;58(4):961-71.
19.Ramani J, Malhotra A, Wadhwa V, et al. Single-dose lignocaine-based blood cardioplegia in single valve replacement patients. Braz J Cardiovasc Surg.2017;32 (2):90-95.
20.Rao P, Keenan JB, Rajab TK, et al. Intraoperative thermographic imaging to assess myocardial distribution of Del Nido cardioplegia. J Card Surg. 2017;32(12):812-815.
21.Momin AA, Chemtob RA, Lopez DC, et al. Open sternum, cooler heart: The effect of surgical approach on myocardial temperature. JTCVS Tech. 2020;1:41-42.
22.Boldt J, Kling D, Dapper F, et al. Myocardial temperature during cardiac operations: influence on right ventricular function. J Thorac Cardiovasc Surg. 1990;100(4):562-8.
23.Daily PO, Jones B, Folkerth TL, et al. Comparison of myocardial temperatures with multidose cardioplegia versus single-dose cardioplegia and myocardial surface cooling during coronary artery bypass grafting. J Thorac Cardiovasc Surg.1989;97(5):715-24.
24.Okamoto H, Tamenishi A, Nishi T, et al. Analysis of myocardial temperature changes in conventional isolated coronary artery bypass grafting. Gen Thorac Cardiovasc Surg. 2014;62(12):706-12. | ||
|
Statistics Article View: 136 PDF Download: 109 |
||