Retrospective evaluation of cases using two different cardioplegia solutions

Introduction: Myocardial protection methods are one of the basic issues of open heart surgery. Cardiac dysfunction, which occurs secondarily to ischemia-reperfusion injury, is directly related to the postoperative morbidity and mortality.This study aims to evaluate the effects of the modified Del Nido cardioplegia and whole blood cardioplegia, the cardioplegia methods applied during the extracorporeal circulation, on the cardiac and renal functions. Materials and methods: The study was carried out on a total of 100 patients who underwent open heart surgery between January 2015 and January 2017 in the Cardiovascular Surgery Clinic of Private Denizli Cerrahi Hastanesi. The patient groups were screened based on retrospective data analysis.The information was obtained from the perfusionist records of the patients in the surgery, operation notes and intensive care patient follow-up forms. This data was obtained from the archive records and database of Private Denizli Cerrahi Hastanesi. Among these patients, adult patients aged 30 years and over, patients who underwent open heart surgery under elective conditions, and patients with aortic cross-clamp time of 60 minutes or more were included in the study. The patients were divided into two groups,each comprising an equal number of 50 patients, as those who were administered the"Modified Del Nido cardioplegia solution" (Group I) and those who were administered the"Complete Blood Cardioplegia solution" (Group II). Findings: The patients were divided into two equal groups as modified Del Nido cardioplegia (Group I) (n=50) and whole blood cardioplegia (Group II) (n=50) according to the type of cardioplegia solution used. A total of 100 patients, 56 (56%) male and 44 (44%) female, were selected as simply randomized patients according to the research criteria. The mean age of the patients in the study was determined to be 59.79±11.43. There was no significant difference between the two groups in terms of mean ages (p=0.3). The mean cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) durations of the patients were 153.50 (94/347) minutes and 95 (61/290) minutes respectively. There was no significant difference between the two groups in terms of the mean CPB and ACC times (p=0.598 and p=0.414, respectively). The mean postoperative pH value of the patients was 7.39 ± 0.03. When the patients were evaluated in terms of their base deficit values, the mean base deficit mean of all patients was determined to be -1.22 ± 1.63. There was no statistically significant difference between the two groups in terms of pH and base deficit values (p=0.057 and p=0.212, respectively). There was no statistically significant difference between the two groups in terms of diabetes mellitus (DM) and hypertension (HT) (p=0.541 and p=0.548, respectively). There was no statistically significant difference between the two groups in terms of postoperative inotropic use, and the development of pacemaker and defibrillation requirement (p=0.803, p=0.356, and p=0.269, respectively). When the patients were evaluated according to pre-op and post-op LVEF changes, the LVEF change in Group I was significantly higher than Group II (p<0.001). Patients were also evaluated for changes in urea and creatinine values in terms of changes in the renal function tests. There was a significant increase in the urea values of both groups in the postoperative period (p<0.001). The urea increase in Group II was found to be statistically significantly higher than that of Group I (p<0.001). The creatinine increase in Group II in the postoperative period was statistically significantly higher than that of group I (p<0.001). Conclusion: In conclusion,the uses of "modified Del Nido cardioplegia solution" and "whole blood cardioplegia solution" have similar clinical outcomes in open heart surgery. However, the "modified Del Nido cardioplegia solution" seems to have better renal and cardiac protective effects in the postoperative period compared to the "whole blood cardioplegia solution". There is a need for more extensive randomized prospective studies on this subject. Keywords:Cardiopulmonary bypass, myocardial protection, blood cardioplegia, modified Del Nido cardioplegia.