Clinical Outcomes and Electrolyte Balance Factors in Complex Cardiac Operations in Adults; Del Nido® Versus Custodiol® Cardioplegia Solutions: A Randomized Controlled Clinical Trial

Background: Cardioplegia is used for protection of myocardium during cardiac operations. Del Nido® (DN) and Custodiol® cardioplegia (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 and postoperative 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.