TITLE:
Analysis of the Effects of Different Forms of Cardioplegia on the Degree of Myocardial Damage and Systemic Inflammation in Patients Undergoing Valvular Heart Disease Surgery
AUTHORS:
Bernardo Ferreira Americano do Brasil, Denilson Campos de Albuquerque, Mário Castro Alvarez Perez, Pedro Ricardo Garcia Jazbik, Henrique Madureira da Rocha Coutinho, Gustavo Kikuta, José Hamilton de Carvalho Torres, Joaquim Henrique de Souza Aguiar Coutinho
KEYWORDS:
Cardiac Arrest, Induced, Cardioplegia, Solutions, Heart Surgery
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.15 No.8,
August
20,
2025
ABSTRACT: Introduction: Myocardial protection plays a fundamental role in obtaining good results in cardiac surgery. Among the several solutions proposed for myocardial protection, the balanced Del Nido’s solution has gained much attention. Recently, a proposal was launched to modify the crystalloid media routinely used in such solutions with the replacement of Plasma-Lyte® by Ringer with lactate. Methods: This is a controlled, interventional, clinical trial, including patients submitted to valvular heart surgeries, performed at two centers in Rio de Janeiro, Brazil. Forty-three patients were stratified into two groups at random. Group A (n = 22) was composed of patients undergoing on-pump heart surgery using the cardioplegic solution modified with Ringer-lactate, while Group B (n = 21) represented the control group (standard Plasma-Lyte® cardioplegic solution). Serum levels of inflammatory (TNF-alpha and interleukin-6) and cardiac damage biomarkers (troponin and lactate) were measured immediately before (T0) and after (between 6 and 24 hours—T1) the surgical procedure, and then remeasured on the third postoperative day (T3). Results: Both groups were homogenous at baseline. There were no significant differences between groups in any of the biomarker measurements at any time, except for TNF-alpha at T0 (p = 0.005). The deltas of the dosages of lactate, troponin, TNF-alpha, and interleukin-6 along the period of analysis also were similar between groups. Discussion: The inflammatory response induced by exposure to the modified Del Nido’s cardioplegic solution, by comparing IL-6 and TNF-alpha levels, showed no significant difference in relation to the standard solution. Also, the degree of myocardial injury and necrosis compared through lactate and troponin measurements showed no significant differences between groups. Conclusion: Both Del Nido’s cardioplegic solution modified with Ringer-lactate and the standard Plasmalyte® cardioplegic solution proved to be effective in cardioprotection of adult patients undergoing valvular heart surgery.