The effects of St. Thomas I and St. Thomas II Cardioplegia Solutions on Coronary Sinus Lactate in Mitral Valve Surgery; A Randomized, Double-blinded, Clinical Trial

Document Type : Original Article

Authors

1 Department of Extra-Corporeal Circulation (ECC), Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Anesthesiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Critical Care, Razavi Hospital, Mashhad, Iran

5 Department of Extra-Corporeal Circulation (ECC), Razavi Hospital, Mashhad, Iran

Abstract

Background: Cardiac protection strategies in different methods are challenging and crucial, affecting postoperative morbidity and mortality.
 
Objectives: We compared the cardio-protective effect of two cardioplegia solutions based on coronary sinus lactate levels.
 
Methods: This randomized, double-blinded clinical trial study was performed on 46 candidates for mitral valve replacement between June 2020 and January 2021. The patients were categorized via block randomization method: 1) St. Thomas I cardioplegia (n=23) and St. Thomas Ⅱ cardioplegia (n=23). The coronary sinus lactate levels at different times were measured. In addition, some intra-operative and clinical characteristics after cardiac surgery were recorded. Data were analyzed in SPSS software (version 26.0) using paired and independent t-tests, repeated measure ANOVA, and Pearson correlation test at a significance level of P < 0.05.
 
Results: In the time trend, the lactate levels in patients with St. Thomas Ⅱ cardioplegia solution had a significantly lower rate than in St. Thomas I (P=0.001). The two groups displayed no statistical difference between the aortic cross-clamp time (P=0.069) and the CPB time (P=0.091). Furthermore, the weaning from mechanical ventilation (P=0.078) and ICU stay (P=0.061) demonstrated no statistical difference between the study groups.
 
Conclusion: Based on significantly lower measures of the coronary sinus lactate, the St. Thomas Ⅱ cardioplegia solution showed a better cardio-protective effect in patients undergoing mitral valve surgery.
 

Keywords

Copyright © 2024, Razavi International Journal of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

1. Heusch G. Myocardial ischemia-reperfusion injury and cardioprotection in perspective. Nat Rev Cardiol. 2020;17(12): 773-89. doi: 10.1038/s41569-020-0403-y. [PubMed: 32620851].
https://doi.org/10.1038/s41569-020-0403-y
PMid:32620851
 
2. Hamad R, Nguyen A, Laliberté É, Bouchard D, Lamarche Y, El-Hamamsy I, et al. Comparison of del Nido cardioplegia with blood cardioplegia in adult combined surgery. Innovations (Phila). 2017;12(5): 356-62. doi: 10.1097/IMI.0000000000000403. [PubMed: 29016380].
https://doi.org/10.1097/imi.0000000000000403
PMid:29016380
 
3. Mousavizadeh M, Ghanbari A, Zirak N, Ghadrdoost B, Yaghubi M, Hosseini S. Comparative myocardial protection effects of Buckberg and del Nido in Mitral Valve Surgery: A Prospective Randomized Trial. Int Cardio Res J. 2021;15(4): e117124.
 
4. Kim WH, Park JY, Ok SH, et al. Association between the neutrophil/lymphocyte ratio and acute kidney injury after cardiovascular surgery: a retrospective observational study. Medicine (Baltimore). 2015;94(43): e1867.doi: 10.1097/MD.0000000000001867. [PubMed: 26512598].
https://doi.org/10.1097/MD.0000000000001867
PMid:26512598 PMCid:PMC4985412
 
5. Pearse RM, Wijeysundera DN. Steroids for cardiac surgery: has the story finally ended?. Lancet. 2015;386: 1215-16. doi: 10.1016/S0140-6736(15)00303-7. [PubMed: 26460640].
https://doi.org/10.1016/S0140-6736(15)00303-7
PMid:26460640
 
6. Floh AA, Manlhiot C, Redington AN, McCrindle BW, Clarizia NA, Caldarone CA, et al. Insulin resistance and inflammation are a cause of hyperglycemia after pediatric cardiopulmonary bypass surgery. J Thorac Cardiovasc Surg. 2015;150(3):498-504.e1. doi: 10.1016/j.jtcvs.2015.06.028. [PubMed: 26190660].
https://doi.org/10.1016/j.jtcvs.2015.06.028
PMid:26190660
 
7. Chowdhury UK, Sheil A, Kapoor PM, Narang R, Gharde P, Malik V, et al. Short-term prognostic value of perioperative coronary sinus-derived-serum cardiac troponin-I, creatine kinase-MB, lactate, pyruvate, and lactate-pyruvate ratio in adult patients undergoing open heart surgery. Ann Card Anaesth. 2016;19(3):439-53. doi: 10.4103/0971-9784.185526. [PubMed: 27397448].
https://doi.org/10.4103/0971-9784.185526
PMid:27397448 PMCid:PMC4971972
 
8. Healey CM, Kumbhani DJ, Healey NA, Crittenden MD, Gibson SF, Khuri SF. Impact of intraoperative myocardial tissue acidosis on postoperative adverse outcomes and cost of care for patients undergoing prolonged aortic clamping during cardiopulmonary bypass. Am J Surg. 2009;197(2):203-10. doi: 10.1016/j.amjsurg.2008.01.023. [PubMed: 18722580].
https://doi.org/10.1016/j.amjsurg.2008.01.023
PMid:18722580
 
9. Raicea V, Kovacs J, Moraru L, Suciu H. Coronary Sinus Lactate as Marker of Myocardial Ischemia in Cardiac Surgery: Correlation with Morbidity and Mortality after Cardiac Surgery / Lactatul din sinusul coronarian - marker al ischemiei miocardice în chirurgia cardiacă: corelaţii cu morbiditatea şi mortalitatea postoperatorie. RJLabMed. 2015;23(2): 189-197. doi: 10.1515/rrlm-2015-0019.
https://doi.org/10.1515/rrlm-2015-0019
 
10. Yamamoto H, Yamamoto F. Myocardial protection in cardiac surgery: a historical review from the beginning to the current topics. Gen Thorac Cardiovasc Surg. 2013;61(9):485-96. doi: 10.1007/s11748-013-0279-4. [PubMed: 23877427].
https://doi.org/10.1007/s11748-013-0279-4
PMid:23877427
 
11. Ghasemi F, Azarfarin R, Salahi S, Baharestani B, Alizadeh Ghavidel A. The Effects of Cold Blood Cardioplegia with and without Adenosine on Hemodynamic Status of Patients Undergoing Mitral Valve Surgery. Multidiscip Cardio Annal. 2020;11(1):e96919. doi: 10.5812/mca.96919.
https://doi.org/10.5812/mca.96919
 
12. Vaidya S, Adhikari AB, Karmacharya R, Rai K. Comparative study between the use of St. Thomas' II cardioplegia and del Nido cardioplegia in patients who underwent open-heart surgery. Nepal. heart j. 2020;17(1):23-7. doi: 10.3126/njh.v17i1.28802.
https://doi.org/10.3126/njh.v17i1.28802
 
13. Sharma A, Dixit S, Mittal S, Sharma M, Sharma D, Mawar KK. DelNido cardioplegia versus St Thomas cardioplegia solution in double valve replacement: a single centre experience. Perfusion. 2021;36(5):476-481. doi: 10.1177/0267659120961921. [PubMed: 33203307].
https://doi.org/10.1177/0267659120961921
PMid:33203307
 
14. Moktan Lama PB, Khakural P, Sigdel S, Raj Bhatta M, Sah Teli R, Baral RK, et al. Del Nido Cardioplegia in Coronary Artery Bypass Grafting Surgery: A safe, efficacious and economic alternative to St. Thomas solution; an experience from a developing nation. Perfusion. 2021 ;36(5):470-475. doi: 10.1177/0267659121991033. [PubMed: 33509043].
https://doi.org/10.1177/0267659121991033
PMid:33509043
 
15. Mohammed S, Menon S, Gadhinglajkar SV, Baruah SD, Ramanan SV, Gopalakrishnan KA, Suneel PR, Dharan BS. Clinical outcomes of del nido cardioplegia and st thomas blood cardioplegia in neonatal congenital heart surgery. Ann Card Anaesth. 2022;25(1):54-60. doi: 10.4103/aca.aca_220_20. [PubMed: 35075021].
https://doi.org/10.4103/aca.aca_220_20
PMid:35075021 PMCid:PMC8865356
 
16. Onorati F, Cristodoro L, Caroleo S, Esposito A, Amantea B, Santangelo E, et al. Troponin I and lactate from coronary sinus predict cardiac complications after myocardial revascularization. Ann Thorac Surg. 2007;83(3):1016-23. doi: 10.1016/j.athoracsur.2006.10.103. [PubMed: 17307451].
https://doi.org/10.1016/j.athoracsur.2006.10.103
PMid:17307451
 
17. White HD. Pathobiology of troponin elevations: do elevations occur with myocardial ischemia as well as necrosis? J Am Coll Cardiol. 2011;57(24):2406-8. doi: 10.1016/j.jacc.2011.01.029. [PubMed: 21658560].
https://doi.org/10.1016/j.jacc.2011.01.029
PMid:21658560
 
18. Fathi M, Valaei M, Ghanbari A, Ghasemi R, Yaghubi M. Comparison of Patient's Kidney Function Based on Kidney Disease Improving Global Outcomes (KDIGO) Criteria and Clinical Parameters in Isolated Coronary Artery Bypass Graft (CABG) Surgery in On-Pump and Off-pump Methods in Patients with Low Cardiac Output Syndrome (LCOS) After Surgery. Anesth Pain Med. 2020;10(2):e100517. doi: 10.5812/aapm.100517. [PubMed: 32754433].
https://doi.org/10.5812/aapm.100517
PMid:32754433 PMCid:PMC7352649
 
19. Buel ST, Striker CW, O'Brien JE. del Nido versus St. Thomas Cardioplegia Solutions: A Single-Center Retrospective Analysis of Post Cross-Clamp Defibrillation Rates. J Extra Corpor Technol. 2016;48(2):67-70. [PubMed: 27578896].
https://doi.org/10.1051/ject/201648067
 
20. Mishra P, Jadhav RB, Mohapatra CK, Khandekar J, Raut C, Ammannaya GK, et al. Comparison of del Nido cardioplegia and St. Thomas Hospital solution - two types of cardioplegia in adult cardiac surgery. Kardiochir Torakochirurgia Pol. 2016;13(4):295-299. doi: 10.5114/kitp.2016.64867. [PubMed: 28096823].
https://doi.org/10.5114/kitp.2016.64867
PMid:28096823 PMCid:PMC5233756
 
21. Barbero C, Pocar M, Marchetto G, Cura Stura E, Calia C, Dalbesio B, et al. Single-Dose St. Thomas Versus Custodiol® Cardioplegia for Right Mini-thoracotomy Mitral Valve Surgery. J Cardiovasc Transl Res. 2023;16(1):192-198. doi: 10.1007/s12265-022-10296-z. [PubMed: 35939196].
https://doi.org/10.1007/s12265-022-10296-z
PMid:35939196 PMCid:PMC9944000
 
22. Talwar S, Bhoje A, Sreenivas V, Makhija N, Aarav S, Choudhary SK, et al. Comparison of del Nido and St Thomas Cardioplegia Solutions in Pediatric Patients: A Prospective Randomized Clinical Trial. Semin Thorac Cardiovasc Surg. 2017;29(3):366-374. doi: 10.1053/j.semtcvs.2017.08.017. [PubMed: 29055711].
https://doi.org/10.1053/j.semtcvs.2017.08.017
PMid:29055711
 
23. Kim JS, Jeong JH, Moon SJ, Ahn H, Hwang HY. Sufficient myocardial protection of del Nido cardioplegia regardless of ventricular mass and myocardial ischemic time in adult cardiac surgical patients. J Thorac Dis. 2016;8(8):2004-10. doi: 10.21037/jtd.2016.06.66. [PubMed: 27621853].
https://doi.org/10.21037/jtd.2016.06.66
PMid:27621853 PMCid:PMC4999689
 
24. Mork C, Koechlin L, Schaeffer T, Schoemig L, Zenklusen U, Gahl B, et al. Bretschneider (Custodiol®) and St. Thomas 2 Cardioplegia Solution in Mitral Valve Repair via Anterolateral Right Thoracotomy: A Propensity-Modelled Comparison. Mediators Inflamm. 2019;2019:5648051. doi: 10.1155/2019/5648051. [PubMed: 31885497].
https://doi.org/10.1155/2019/5648051
PMid:31885497 PMCid:PMC6914981
 
25. Ali I, Hassan A, Shokri H, Khorshed R. Efficacy of Histidine-Tryptophan-Ketoglutarate Solution Versus Blood Cardioplegia in Cardiac Surgical Procedures: A Randomized Controlled | Parallel Group Study. Heart Surg Forum. 2021;24(1):E170-E176. doi: 10.1532/hsf.3495. [PubMed: 33635238].
https://doi.org/10.1532/hsf.3495
PMid:33635238
 
26. Lin YZ, Huang JB, Li XW, Tang XM, Lu WJ, Wen ZK, et al. Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution. Exp Ther Med. 2017;14(3):2677-2682. doi: 10.3892/etm.2017.4814. [PubMed: 28962211]
https://doi.org/10.3892/etm.2017.4814
PMid:28962211 PMCid:PMC5609297
Razavi International Journal of Medicine
Volume 11, Issue 3
August 2023
Pages 12-16

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