Comparing the Myocardial Protection of Custodiol Alone and in Combination with Modified Del Nido in Patients Undergoing Cardiac Surgery; A Double-Blind Randomized Clinical Trial

AUTHORS

Neda Reihanifard ORCID 1 , Mohammad Hassan Nemati ORCID 2 , * , Seyed Hedayatollah Akhlagh ORCID 3 , Ali Mohammad Keshtvarz Hesam Abadi 4

1 Student Research Committee of Shiraz University of Medical Sciences, Shiraz, IR Iran

2 Department of Surgery, Section of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran

3 Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran

4 Clinical Research Development Center of Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran

How to Cite: Reihanifard N, Nemati M H, Akhlagh S H , Keshtvarz Hesam Abadi A M. Comparing the Myocardial Protection of Custodiol Alone and in Combination with Modified Del Nido in Patients Undergoing Cardiac Surgery; A Double-Blind Randomized Clinical Trial, Int Cardio Res J. 2020 ; 14(3):e104728.

ARTICLE INFORMATION

International Cardiovascular Research Journal: 14 (3); e104728
Published Online: September 01, 2020
Article Type: Research Article
Received: May 08, 2020
Accepted: August 15, 2020
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Abstract

Background: Coronary Artery Bypass Grafting (CABG) has been considered as the
complete treatment of Ischemic Heart Disease (IHD). Cardioplegic (extracellular and
intracellular) solutions have been suggested to reduce the cross-clamping duration. It
was hypothesized that the combination of the two intra- and extra-cellular solutions,
namely Del Nido (DN) and custodiol, could result in beneficiary clinical and economic
outcomes.
Objectives: The present study aimed to compare the myocardial protection of custodiol
alone and in combination with modified DN in patients undergoing cardiac surgery.
Methods: This prospective, double-blind, clinical trial was conducted on 50 patients
undergoing redo CABG surgery. Aortic clamping was performed using custodiol (20
cc/kg) in group A. In group B, custodiol 1000 cc was combined with 15 cc/kg cold DN
and was injected using the antigrade method. The two groups were compared regarding
the levels of Creatinine Kinase-MB (CK-MB) and troponin at the time of anesthesia
induction and two hours and 48 hours after the surgery, intraoperative and postoperative
variables, and 48–hour mortality rate.
Results: The results showed similar CK-MB levels in the two groups at the induction time
(P = 0.12). However, a significant difference was observed between the two groups in this
regard two hours (P = 0.018) and 48 hours after the surgery (P = 0.021). Within-group
comparisons revealed significant changes in CK-MB and troponin levels in both groups,
with a steep increase from induction until two hours after the surgery and a decrease
from two hours until 48 hours after the surgery (P < 0.001). The results indicated no
significant difference between the two groups regarding CK-MB and troponin levels,
frequency of intraoperative and postoperative dysrhythmia, need for intraoperative
defibrillation, ischemic time, and 48-hour mortality rate (P > 0.05). However, the costs
were two-folds higher in group A than in group B (P < 0.001).
Conclusions: The present study findings showed that the selected solution was appropriate
in terms of clinical aspects for the patients undergoing CABG surgery with long surgical
duration or low Ejection Fraction (EF) and reduced the costs to half. Considering the
significant difference in the CK-MB level and the lower troponin level in the combined
group (not statistically significant), further studies are required to confirm the clinical
priority of the combined solution.

© 0, Shiraz University of Medical Sciences.

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