Del Nido versus conventional cardioplegia comparison in term of myocardial protection using cardiac enzymes in patients undergoing coronary artery bypass surgery

Abstract

Introduction: Myocardial protection is the major component in cardiac surgery affecting the patient’s outcome (morbidity and mortality). The key components are cardiopulmonary bypass (CPB), hypothermia and the cardioplegia solution. Objective: To compare conventional vs Del Nido cardioplegias using Cardiac Troponin-I (CTnI) and CK MB release as the primary outcome variable in patients with preserved left ventricular ejection fraction undergoing coronary artery bypass surgery. Material and Methods: Retrospective comparative study conducted at Punjab Institute of Cardiology, cardiac surgery department. After informed consent, patients undergoing coronary artery bypass surgery were included in the study. Data was analyzed by comparing Del-Nido with Conventional Cardioplegia using CTnI and CKMB release as the primary outcome variable. Results: A total of 140 patients were divided in two groups 70 (50%) in Del-Nido group and 70 (50%) in conventional group. In Del Nido group the mean Cardioplegia volume given was 1271.43 ± 447.91 ml and in Conventional Cardioplegia mean volume given was 2142.86 ± 584.48 ml with p-value <0.005. The comparison of Troponin I (ug/ml) levels post-operatively after 6, 9, 12 and 24 hours and on 5th day in Del Nido and conventional Cardioplegia groups showed insignificant p-values of 0.797, 0.977, 0.956, 0.496 and 0.297 respectively, which depicted that there is no remarkable difference in Troponin I levels regarding times in both groups. The comparison of CKMB (IU/L) levels in both groups after 6 hours 24 hours and on 5th day of CABG showed significant p-value of 0.032, 0.027 and 0.001 respectively and determined the difference in both groups. Whilst the comparison of CKMB (IU/L) levels post-operatively after 9 and 12 hours of CABG in both groups showed insignificant p-values of 0.706 and 0.476 respectively which implied that there is no major difference in CKMB levels regarding times in both groups. Conclusion:  The key benefits of Del Nido cardioplegia, which makes it preferable to conventional cardioplegia, are less volume needed and an uninterrupted operation. While time related troponin I and CKMB levels changes showed almost similar results in both groups. So we can say both groups are equally safe and have same outcomes.