A Comparative Study of the Clinical Implications of Cardioplegia Infusion Between the Microplegia Technique and Del Nido Cardioplegia Among Patients Undergoing Coronary Artery Bypass Surgery

Document Type : Original Article

Authors

1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Young Researchers and Elites Club, Faculty of Medicine, Islamic Azad University, Yazd Branch, Yazd, IR Iran.

Abstract

Background: Cardioplegia is used to protect the heart from ischemic injury during cardiovascular bypass. We randomly selected candidates for coronary artery bypass surgery undergoing either microplegia or del Nido cardioplegia.
 
Methods: We performed a controlled randomized double-blind study to evaluate 60 patients undergoing coronary artery bypass surgery in Rajaie Cardiovascular Medical and Research Center during a 3-month period. During surgery, the case group received microplegia, and the control group received del Nido cardioplegia. Preoperative, intraoperative, and postoperative personal information was collected from the patients’ records, and the data were analyzed using the SPSS software, version 22, using appropriate statistical tests.
 
Results: Out of 60 patients under study, 28 patients underwent microplegia, and 32 patients received del Nido cardioplegia. The patients, randomly assigned to the groups, did not significantly differ concerning height, weight, and body surface area. No significant differences existed between the 2 groups. The levels of postoperative decreases in hemoglobin and hematocrit were significant in the microplegia group and led to an increase in the number of blood transfusions in the intensive care unit. A significant increase in CK-MB was observed in the del Nido group 24 hours after surgery.
 
Conclusions: Microplegia, compared with del Nido cardioplegia, conferred proper myocardial protection. However, the use of the microplegia technique was associated with more significant decreases in hemoglobin and hematocrit postoperatively, and the beneficial effects of microplegia in reducing hemodilution were not well-reflected. (Iranian Heart Journal 2023; 24(1): 31-38)

Keywords


  1. Aghamohammadi S, Kazemi E, Khosravi A, Kazemeini H. The trend of ten leading causes of death in the Islamic Republic of Iran, 2006-2011. Iranian Journal of Epidemiology. 2017 Feb 15; 12(4):1-1.
  2. Forouzanfar MH, Sepanlou SG, Shahraz S, BESc PN, Pourmalek F, Lozano R, Asadi-Lari M, Sayyari AA, Dphi CJ, Naghavi M. Evaluating causes of death and morbidity in Iran, global burden of diseases, injuries, and risk factors study 2010. Archives of Iranian medicine. 2014 May 1; 17(5):304.
  3. Viana FF, Shi WY, Hayward PA, Larobina ME, Liskaser F, Matalanis G. Custodiol versus blood cardioplegia in complex cardiac operations: an Australian experience. European Journal of Cardio-Thoracic Surgery. 2012 Jun 4; 43(3):526-31.
  4. Matte GS, Pedro J. History and use of del Nido cardioplegia solution at Boston Children’s Hospital. The Journal of extra-corporeal technology. 2012 Sep; 44(3):98.
  5. Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed?. The Journal of thoracic and cardiovascular surgery. 2003 Jun 1; 125(6):1438-50.
  6. Günday M, Bingöl H. Is crystalloid cardioplegia a strong predictor of intra-operative hemodilution?. Journal of cardiothoracic surgery. 2014 Dec; 9(1):23.
  7. El-Hamamsy I, Stevens LM, Pellerin M, Bouchard D. A prospective randomized study of diluted versus non-diluted cardioplegia (minicardioplegia) in primary coronary artery bypass surgery. Journal of Cardiovascular Surgery. 2004 Apr 1; 45(2):101.
  8. Onorati F, Dobson GP, San Biagio L, Abbasciano R, Fanti D, Covajes C, Menon T, Gottin L, Biancari F, Mazzucco A, Faggian G. Superior myocardial protection using “polarizing” adenosine, lidocaine, and Mg2+ cardioplegia in humans. Journal of the American College of Cardiology. 2016 Apr 12; 67(14):1751-3.
  9. Menasché P. Strategies to improve myocardial protection during extracorporeal circulation. Shock (Augusta, Ga.). 2001 Jan 1; 16:20-3.
  10. O’Rullian JJ, Clayson SE, Peragallo R. Excellent outcomes in a case of complex re-do surgery requiring prolonged cardioplegia using a new cardioprotective approach: adenocaine. The Journal of extra-corporeal technology. 2008 Sep; 40(3):203.
  11. Vinten-Johansen J. Whole Blood Cardioplegia: Do We Still Need to Dilute?. The journal of extra-corporeal technology. 2016 Jun; 48(2):P9.
  12. Kuhn EW, Liakopoulos O, Slottosch I, Deppe AC, Choi YH, Madershahian N, Wahlers TC. Buckberg versus Calafiore cardioplegia in patients with acute coronary syndromes. The Thoracic and cardiovascular surgeon. 2018 Sep; 66(06):457-63.