Modified Del Nido Versus Custodiol Cardioplegia For Myocardial Protection In Cardiac Surgery.

Summary

Cardioplegia solutions have been considered as a corner stone for myocardial protection during cardiac surgery with cardiopulmonary bypass and cardiac arrest, it limits the metabolic activity and increases the capacity of the myocardium to withstand prolonged ischemic time, and thus it has a direct impact on surgical outcomes. (1, 2) Long acting cardioplegic solutions with a single dose strategy are beneficial as they allow surgery without interruptions, reducing cross clamp time and provide more cardiac protection. (3) Custodiol (histidine- tryptophan- ketoglutarate) solution has been described in the 1970s by Bretschneider (4), and used as an alternative to hyperkalemic crystalloid solutions especially during complex cardiac surgeries, also used for organ preservation during transplant surgery. (5, 6) In the 1990s Pedro del Nido and his team introduced a new cardioplegic solution (del Nido cardioplegia) for pediatric cardiac surgeries. (7) But recently, many studies postulated its use for adults. (8) The base solution for the traditional del Nido cardioplegia is Plasma-Lyte A which is a calcium free solution and electrolyte composition similar to the extracellular fluid. (7) However Plasma-Lyte A is unavailable in many countries, this precludes its use. Some authors have advocated lactated Ringer's as a base solution instead of Plasma-Lyte A for preparing del Nido cardioplegia, now known as modified del Nido cardioplegia. (9) Custodiol and modified del Nido cardioplegia can be used in a single dose fashion with proper myocardial protection and minimal surgical interruptions. However, the literature also does not confirm the superiority of one over another. (1) Also, limited number of clinical trials compared both cardioplegic solutions directly. So, in this study we aimed to assess the efficacy of both Custodiol and modified del Nido cardioplegia in myocardial protection and clinical outcomes among adult patients undergoing cardiac surgery.

Timeline

Start

2022-02-01

Primary completion

2023-11-15

Completion

2023-11-30

Publications

• Results Sanetra K, Pawlak I, Cisowski M. Del Nido cardioplegia - what is the current evidence? Kardiochir Torakochirurgia Pol. 2018 Jun;15(2):114-118. doi: 10.5114/kitp.2018.76477. Epub 2018 Jun 25.
• Results Vivacqua A, Robinson J, Abbas AE, Altshuler JM, Shannon FL, Podolsky RH, Sakwa MP. Single-dose cardioplegia protects myocardium as well as traditional repetitive dosing: A noninferiority randomized study. J Thorac Cardiovasc Surg. 2020 May;159(5):1857-1863.e1. doi: 10.1016/j.jtcvs.2019.03.125. Epub 2019 May 11.
• Abdelhady MA, Goda AS, Sayed Gomaa MS, Hamed MA, Hassan AASM. Modified Del Nido Versus Custodiol(R) Cardioplegia for Myocardial Protection in Adult Patients Undergoing Cardiac Surgery; A Prospective Randomized Double-Blinded Clinical Trial. Ann Card Anaesth. 2025 Oct 1;28(4):451-458. doi: 10.4103/aca.aca_35_25. Epub 2025 Oct 13.

Drugs

Indications

No indication recorded.