Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegia solutions in pediatric patients undergoing open heart surgery: A prospective randomized clinical trial

Talwar, Sachin; Chatterjee, Sujoy; Sreenivas, Vishnubhatla; Makhija, Neeti; Kapoor, Poonam Malhotra; Choudhary, Shiv Kumar; Airan, Balram

doi:10.1016/j.jtcvs.2018.09.140

Cited by 19 publications

(20 citation statements)

References 19 publications

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“…Talwar et al 24 randomised 100 paediatric patients submitted to elective surgical correction of Fallot’s tetralogy to receive cardioplegic solutions del Nido or Custodiol. The first was associated with the better preservation of the cardiac index, shorter mechanical ventilation time, shorter stay at the ICU and the hospital, better cardiac output, lower inotropic scores and lower release of troponin-I.…”

Section: Discussionmentioning

confidence: 99%

“…The sample size calculation was performed using the G-Power program V.3.1.9.4. Considering an effect f=0.466 on troponin levels based on the study by Talwar et al , 24 maintaining a 95% statistical power and a 5% significance, it would be necessary to investigate 75 patients. Thus, with an additional 20% to account for potential losses, 90 individuals will be selected for the study, with 30 randomised for each group.…”

Section: Methods and Analysismentioning

confidence: 99%

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Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial

et al. 2021

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IntroductionMyocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study.Methods and analysisThis is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters.Ethics and disseminationThis protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field.Trial registration numberRBR-7g5s66.

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Section: Discussionmentioning

confidence: 99%

Section: Methods and Analysismentioning

confidence: 99%

Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial

et al. 2021

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“…The sample size was determined based on a similar study on single-dose cardioplegia. 16 Using the protocol, 65 patients were needed in each group to show a statistically significant difference with 5% error and 80% power. Giving an allowance for attrition and incomplete data of patients during follow-up, a sample size of 90 was targeted in each group.…”

Section: Methodsmentioning

confidence: 99%

Clinical outcomes of single-dose cardioplegia in high-risk coronary bypass

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Babaroglu

et al. 2020

Asian Cardiovasc Thorac Ann

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Background Despite the increasing popularity of single-dose cardioplegia techniques in coronary artery bypass grafting, the time window for successful reperfusion remains unclear. This study aimed to compare different cardioplegic techniques based on early and 30-day clinical outcomes via thorough monitoring. Methods This prospective cohort study included high-risk patients undergoing coronary artery bypass grafting and receiving 3 different types of cardioplegia between January 2017 and June 2019. Group 1 ( n = 101) had a single dose of del Nido cardioplegia, group 2 ( n = 92) had a single dose of histidine-tryptophane-ketoglutarate, and group 3 ( n = 119) had cold blood cardioplegia. Patients were examined perioperatively by memory loop recording and auto-triggered memory loop recording for 30 days, with documentation of predefined events. Results Interleukin-6 and cardiac troponin levels in group 1 were significantly higher than those in groups 2 and 3. The incidence of predefined events as markers of inadequate myocardial protection was significantly higher group 1, with more frequent atrial fibrillation attacks and more hospital readmissions. The readmission rate was 17.6% in group 1, 9% in group 2, and 8% in group 3. Conclusions Our data demonstrate the long-term efficacy of cardioplegic techniques, which may become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial protection. Patients given del Nido cardioplegia had a significantly more prominent inflammatory response and higher troponin levels after cardiopulmonary bypass. This group had issues in the longer term with significantly more cardiac events and a higher rehospitalization rate.

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“…Although the use of cardioplegic solutions has improved outcomes following cardiac surgery [25], different levels of protection are reported in specific populations. For example, better outcomes after cardiac surgery are observed when del Nido cardioplegia is used when compared to standard cardioplegia, in particular in pediatric patients [26, 27]. There is also evidence for sex-specific differences in the efficacy of standard cardioplegic solution, with lower cardiac protection reported in females compared to males [28].…”

Section: Introductionmentioning

confidence: 99%

Ischemia and reperfusion injury following cardioplegic arrest is attenuated by age and testosterone deficiency in male but not female mice

2019

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Background Cardiovascular disease increases with age in both sexes. Treatment can require cardiac surgery, where the hearts are pre-treated with protective cardioplegic solution before ischemia and reperfusion (I/R). While endogenous estrogen is beneficial in I/R, whether testosterone is involved is uncertain and whether age modifies responses to I/R is unclear. We investigated sex- and age-specific differences in I/R injury in the hearts pre-treated with clinically relevant cardioplegic solution. Methods The hearts were isolated from young (6–9 months) and old (20–28 months) mice of both sexes and perfused (Langendorff) with Krebs-Henseleit buffer (15 min, 37 °C), followed by St. Thomas’ two cardioplegia (6 min, 6–7 °C), global ischemia (90 min, 23–24 °C), and reperfusion (30 min, 37 °C). The hearts were perfused with triphenyltetrazolium chloride to quantify infarct area. Testosterone’s role was investigated in gonadectomized (GDX, 6–9 months) male mice; serum testosterone and estradiol were measured with ELISA assays. Results Left ventricular developed pressure (LVDP) recovered to 67.3 ± 7.4% in the old compared to 21.8 ± 9.2% in the young male hearts ( p < 0.05). Similar results were seen for rates of pressure development (+dP/dt) and decay (−dP/dt). Infarct areas were smaller in the old male hearts (16.6 ± 1.6%) than in the younger hearts (55.8 ± 1.2%, p < 0.05). By contrast, the hearts from young and old females exhibited a similar post-ischemic functional recovery and no age-dependent difference in infarcts. There was a sex difference in the young group, where ventricular function (LVDP, +dP/dt, −dP/dt) recovered better and infarcts were smaller in females than males. Estradiol levels were highest in young females. Testosterone was high in young males but low in females and old males, which suggested beneficial effects of low testosterone. Indeed, the hearts from GDX males exhibited much better recovery of LVDP in reperfusion than that from intact males (values were 64.4 ± 7.5 % vs. 21.8 ± 9.2%; p < 0.05). The GDX hearts also had smaller infarcts than the hearts from intact males ( p < 0.05). Conclusions Although age had no effect on susceptibility to I/R injury after cardioplegic arrest in females, it actually protected against injury in older males. Our findings indicate that low testosterone may be protective against I/R injury following cardioplegic arrest in older males. Electronic supplementary material The online version of this article (10.1186/s13293-019-0256-4) contains supplementary material, which is available to authorized users.

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Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegia solutions in pediatric patients undergoing open heart surgery: A prospective randomized clinical trial

Cited by 19 publications

References 19 publications

Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial

Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial

Clinical outcomes of single-dose cardioplegia in high-risk coronary bypass

Ischemia and reperfusion injury following cardioplegic arrest is attenuated by age and testosterone deficiency in male but not female mice

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