Effect of del nido cardioplegia use on kidney injury after coronary bypass operations

SUMMARY OBJECTIVE: After cardiac surgery, acute kidney injury is observed at a rate of 5-30%, and the second most common cause of acute kidney injury in intensive care units is cardiac surgery. In this study, we aimed to investigate the effect of del Nido cardioplegia solution use on postoperative acute kidney injury development in patients who underwent coronary artery bypass grafting operation with cardiopulmonary bypass. METHODS: Consecutive patients who underwent an elective coronary artery bypass grafting operation with cardiopulmonary bypass in our clinic between March 15, 2019, and March 15, 2020, were included in the study retrospectively. The patients were divided into two groups as those who received del Nido cardioplegia solution (Group 1) and blood cardioplegia (Group 2), and factors affecting the development of renal failure were examined. RESULTS: A total of 350 consecutive patients were included in the study. There were 156 patients in the del Nido cardioplegia group and 194 patients in the blood cardioplegia group. Among the patient group, 74 (21.1%) patients developed acute kidney injury. The total acute kidney injury development rate was significantly higher in Group 2 (p=0.018). In multivariate logistic regression analysis, advanced age (OR 1.128; 95%CI 1.044-1.217; p=0.042), increased blood product use (OR 1.318; 95%CI 1.154-1.998; p=0.019), preoperative creatinine elevation (OR 2.434; 95%CI 1.655-4.639; p=0.005), and increased cardioplegia volume (OR 1.254; 95%CI 1.109-2.980; p=0.009) were independent predictors of acute kidney injury. CONCLUSION: With this study, we showed that the use of del Nido cardioplegia solution can reduce the incidence of acute kidney injury.

Ringer acetate versus ringer lactate cardioplegia: a comparative study in mitral valve surgery

Background: ringer lactate has long been used in many surgical procedures as one of the isotonic solutions. However, with the development of Ringer acetate, it becomes the crystalloidof cholce owing to its main metabolism in muscles unlike lactate which is mainly in liver, also it corrects acidosis more rapidly than lactate and it needs less O[2] and produces less CO[2]. Ringer acetate has also a great utility during cardiovascular surgery with cardiopulmonary bypass. We compared efficacy and safety of Ringer acetate versus lactate in preparing cardioplegic solution during mitral valve surgery

Methods: 42 adult patients undergoing mitral valve replacement using CPB were randomly divided into two groups. Patients in group A received antegrade cold Ringer Acetate cardioplegic solution at a rate of l0ml/kg followed after 20 minutes by 5ml/kg retrogradely in the coronary sinus. Patients in group B received cold Ringer Lactate cardioplegic solution in a similar regimen to group A

Results: troponin I level from coronary sinus during reperfusion, was higher in group B than A [4.4+/-l.6ng/ml and 3.4+/-1.49ng/ml respectively] and after 4 and 24 hours postoperatively there was a significant increase in the serum Troponin I level in group B than In group A [p<0.05]. Lactate in the coronary sinus was higher in group B than A during rewarming [2.8+/-1.9ng/ml and 1.6+/-1.8ng/ml respectively]. The serum level was always higher in group B than A in the postoperative period [p<0.05]. There was no significant difference between both groups as regards the post-bypass ischemic changes as detected by TEE examination. Also, there were no differences in the duration of inotropic support, ventilation time, intensive care unit or hospital stay in the two groups

Conclusion: both Ringer Acetate and Lactate cardioplegia provide adequate myocardial protection, however the recovery of the heart from ischemia after the Ringer Acetate cardioplegia is better than Ringer Lactate

Influência do acréscimo de manitol à solução nutriente no desempenho mecânico e no grau de edema miocárdico de coraçoes isolados de ratos / Influence of Mannitol Added to the Perfusion Solution on Mechanical Properties and Myocardial Edema of Isolated Rat Hearts

PURPOSE--To analyse the influence of mannitol added to Krebs-Henseleit (KH) solution on the myocardium edema and myocardial function. METHODS--Isolated rat heart under isovolumetric contractions studied according to Langendorff's technique were perfused with KH solution at constant flow during 90 min. The coronary perfusion pressure, diastolic and systolic pressures were recorded at every 15 min. At the end of the experiment, myocardium water content was measured in hearts perfused with KH solution (group I, n = 9) and in hearts perfused with KH solution plus 8mM mannitol (group II, n = 8). These results were compared to non-perfused control heart (n = 9). RESULTS--Myocardial water content was statistically higher in group I (80.8 +/- 1.3) compared to group II (78.1 +/- 0.7) and control group (75.5 +/- 0.5). Systolic arterial pressure was statistically higher in group I (86.2 +/- 11.5mmHg) compared to group II (72.7 +/- 21.1mmHg). There was no difference in the diastolic pressure between the two groups. Coronary perfusion pressure (Pp) increased progressively during the experiment in both groups. However, Pp was lower in group II than in group I. CONCLUSION--Mannitol added to KH solution significantly attenuates the myocardium edema in the isolated perfused rat heart.