Modified Del Nido Versus Custodiol Cardioplegia For Myocardial Protection In Cardiac Surgery.
Status:
Recruiting
Trial end date:
2022-05-30
Target enrollment:
Participant gender:
Summary
Cardioplegia solutions have been considered as a corner stone for myocardial protection
during cardiac surgery with cardiopulmonary bypass and cardiac arrest, it limits the
metabolic activity and increases the capacity of the myocardium to withstand prolonged
ischemic time, and thus it has a direct impact on surgical outcomes. (1, 2) Long acting
cardioplegic solutions with a single dose strategy are beneficial as they allow surgery
without interruptions, reducing cross clamp time and provide more cardiac protection. (3)
Custodiol (histidine- tryptophan- ketoglutarate) solution has been described in the 1970s by
Bretschneider (4), and used as an alternative to hyperkalemic crystalloid solutions
especially during complex cardiac surgeries, also used for organ preservation during
transplant surgery. (5, 6) In the 1990s Pedro del Nido and his team introduced a new
cardioplegic solution (del Nido cardioplegia) for pediatric cardiac surgeries. (7) But
recently, many studies postulated its use for adults. (8) The base solution for the
traditional del Nido cardioplegia is Plasma-Lyte A which is a calcium free solution and
electrolyte composition similar to the extracellular fluid. (7) However Plasma-Lyte A is
unavailable in many countries, this precludes its use. Some authors have advocated lactated
Ringer's as a base solution instead of Plasma-Lyte A for preparing del Nido cardioplegia, now
known as modified del Nido cardioplegia. (9) Custodiol and modified del Nido cardioplegia can
be used in a single dose fashion with proper myocardial protection and minimal surgical
interruptions. However, the literature also does not confirm the superiority of one over
another. (1) Also, limited number of clinical trials compared both cardioplegic solutions
directly. So, in this study we aimed to assess the efficacy of both Custodiol and modified
del Nido cardioplegia in myocardial protection and clinical outcomes among adult patients
undergoing cardiac surgery.