Résumé
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