Mohammad Javad Mehrabanian; Mehdi Dehghani Firoozabadi; Seyed Hossein Ahmadi Tafti; Seyed Khalil Forouzan Nia; Atabak Najafi; Meysam Mortazian; Sam Zeraatian Nejad Davani; Hassan Soltaninia; Abbas Ghiasi; Farhad Gorjipour; Armita Mahdavi Gorabi
Volume 20, Issue 4 , 2018, Pages 1-8
Abstract
Background: Cardioplegia is used for protection of myocardium during cardiac operations. Del Nido® (DN) and Custodiol® car- dioplegia (CC) solutions are used for prolonged protection of the myocardium during cardiopulmonary bypass (CPB). Custodiol® cardioplegia solution is gaining popularity ...
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Background: Cardioplegia is used for protection of myocardium during cardiac operations. Del Nido® (DN) and Custodiol® car- dioplegia (CC) solutions are used for prolonged protection of the myocardium during cardiopulmonary bypass (CPB). Custodiol® cardioplegia solution is gaining popularity for myocardial protection during cardiopulmonary bypass. Objectives: This study aimed to compare the effects of Custodiol® with another cardioplegia solution, Del Nido®, on myocardial protection during cardiopulmonary bypass. Methods: In a randomized controlled clinical trial, forty patients were randomly allocated to Del Nido® and Custodiol® (CC) groups. Patients in both groups received a standard anesthesia protocol. For cardioplegia, in the DN group, the Del Nido® solution was administered every 90 minutes by the antegrade route. In the CC, group, the Custodiol® solution was administered in the same way at the beginning of the cardioplegia. Demographic information, blood chemistry parameters and other related perioperative andpostoperative clinical indices were recorded. Results: Frequency of female patients was 14/21 (66.66%) in the DN and 12/19 (63.15%) in the CC group (P = 0.816), age was 57.14 ± 12.48 years versus 59.47 ± 11.96 years (P = 0.551), weight was 70.95 ± 9.56 kilograms versus 69.63 ± 7.64 kilograms (P = 0.635), CPB time was 103.19 ± 23.43 minutes versus 97.36 ± 16.7 minutes (P = 0.376), and cross-clamp time was 73.76 ± 19.66 minutes versus 83.95 ± 16.14 minutes (P = 0.083). Blood chemistry and blood gas analysis revealed a similar trend between the two groups in these parameters (P> 0.05) except for higher sodium levels after cardioplegia (P = 0.016) and end of CPB (P = 0.002), potassium levels after cardioplegia (P = 0.029), and bicarbonate anions at the end of bypass (P = 0.03) in the Custodiol® group.Conclusions: In conclusion, CC and DN offer effective myocardial protection during cardiopulmonary bypass. It is recommended to restrict the use of CC in patients susceptible to electrolyte disturbances
Ali Sadeghpour Tabaei; Meysam Mortazian; Alireza Yaghoubi; Farhad Gorjipour; Shaghayegh Arasteh Manesh; Ziae Totonchi; Bahador Baharestani; Mohammadjavad Mehrabanian; Hamidreza Pazoki-Toroudi; Hossein Kaveh; Yaser Toloueitabar; Ameneh Ghanbari; Fazel Gorjipour
Volume 20, Issue 5 , 2018, Pages 1-10
Abstract
Background: Modified Ultrafiltration (MUF) has been used in Cardiopulmonary Bypass (CPB) operations to prevent hemodilution and remove pro-inflammatory cytokines. It has been studied in pediatric operation settings. However, evidence exists regarding its application in adults’ Coronary Artery Bypass ...
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Background: Modified Ultrafiltration (MUF) has been used in Cardiopulmonary Bypass (CPB) operations to prevent hemodilution and remove pro-inflammatory cytokines. It has been studied in pediatric operation settings. However, evidence exists regarding its application in adults’ Coronary Artery Bypass Grafting (CABG) operation.Objectives: The present study investigated MUF and its effects on inflammatory cytokine response, hemodilution and rotational thromboelastometry outcomes in adults’ CABG operation. Methods: In a randomized controlled trial, 56 elective CABG patients that had referred to the Rajaie Cardiovascular Medical andResearch Center (Tehran, Iran) during year 2017 were randomly assigned to two groups, including control and MUF groups. Pre- operative and postoperative clinical parameters were recorded. Serum level of inflammatory cytokines after clamp removal, af- ter Cardiopulmonary Bypass (CPB) (MUF in the MUF group) and 24 hours after Intensive Care Unit (ICU) entrance, and Rotational Thrombo-elastometry (ROTEM) indices, pre-operation, and post-operation, were measured. Results: The two groups were similar in clinical perioperative parameters, including hemodynamics, transfusions, ROTEM indices, mechanical ventilation and CPB time, and ICU stay. The levels of inflammatory mediators were significantly increased after CPB in both groups. Interleukin (IL)-6, -8 and -10 measures were equal between the two groups in all trial measurement points. The MUF group demonstrated a significantly lower level of Tumor Necrosis Factor (TNF)-α compared with the control group after CPB (1.55 ± 0.29 versus 1.77 ± 0.35 log10 pg/mL, respectively; P = 0.031). Hemoglobin (9.55 ± 0.96 versus 8.29 ± 0.57 g/dl, P < 0.001) and hematocrit % (29.96 ± 3.23 and 24.72 ± 1.62, P < 0.001) levels were significantly higher in the MUF group compared with the control, after CPB.Conclusions: Modified Ultrafiltration eliminates extra liquids and TNF-α from circulation in adults CABG operation, without affect- ing the hemostatic indices and improves hemoglobin level. It does not remove anti-inflammatory cytokine IL-10 from circulation.
