A Prospective Comparative study to assess the effect of modified del Nido versus standard del Nido on Myocardial protection in Adults

Objective. This comparative observational study aimed to assess the efficacy and safety of modified del Nido cardioplegia (MDN) prepared using Ringer Lactate [Group R] compared to the standard del Nido cardioplegia (SDN) with Plasmalyte–A [Group P] in adult patients undergoing cardiac surgery with cardioplegic arrest. Materials and Methods. A total of 88 patients were evaluated. The primary outcome of myocardial injury was measured by specific markers viz cardiac Troponin I (cTnI), Creatine Phosphokinase–MB (CPK–MB), and Coronary Sinus (CS) Lactate at various time points. Secondary outcomes were postoperative left ventricular ejection fraction, inotropic score, and duration of intensive care unit (ICU) stay. The differences in primary and secondary outcomes between the groups were measured and analysed. Results. Two primary outcome parameters showed significant differences between the two groups viz. the CS lactate levels measured immediately after the removal of the aortic cross–clamp (group–R 3.23 ± 1.07, group–P 2.58 ± 0.99, p–0.004) and troponin–I levels measured at 24 hours post–surgery (group–R 6.45 ± 4.89, group–P 4.64 ± 3.98, p–0.012). However other primary and secondary parameters did not exhibit significant differences between the two groups. Conclusion. Although there were no significant differences in the secondary outcome parameters, two of the primary outcome parameters associated with myocardial injury showed significant difference. Hence modified del Nido should be used with caution unless the safety is validated by large multi–centric RCTs.