Análise do efeito de diferentes formas de cardioplegia, graus de resposta inflamatória e injúria ao miocárdio em pacientes submetidos a cirurgia cardíaca valvar em hospital terciário

Abstract

Myocardial protection plays a crucial role in achieving favourable outcomes in surgical procedures. Cardiac surgery with extracorporeal circulation is closely associated with the degree of postoperative inflammatory response. It is well-known that levels of TNF-alpha, interleukin 6, and troponin are directly related to the extent of myocardial injury. Nevertheless, a recent proposal to modify the used crystalloid solution, by replacing Plasma-Lyte® with a balanced solution composed of lactated Ringer's solution, has been tested with promising results. This change makes the routine use of the Del Nido solution more accessible without compromising its myocardial protection quality, considering its lower cost and the limited accessibility of Plasma- Lyte® in many countries. This study aims to assess the feasibility by comparing the use of modified Del Nido cardioplegic solution containing lactated Ringer's solution with the original Del Nido solution (Plasma-Lyte®), in terms of the cardioprotection provided to adult patients undergoing valvular cardiac surgeries. It is a clinical, controlled intervention study involving patients undergoing valvular cardiac surgeries, conducted at the Cardiac Surgery Services of Pedro Ernesto University Hospital (HUPE/UERJ) and Naval Hospital Marcilio Dias between January 2020 and October 2022. Initially, 48 patients were selected, but 5 were excluded due to the need for combined surgery, resulting in a total of 43 patients studied. These patients were randomly stratified into two groups through a lottery: Group A (n=22) representing patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), using the modified cardioplegic solution with lactated Ringer's solution, and Group B (n=21) representing the control group, with patients undergoing cardiac surgery with CPB, using the standard cardioplegic solution Plasma-Lyte®. Measurements and analyses of inflammatory biomarkers and cardiac damage were performed at the following time points: preoperative, immediate postoperative (between 6 and 24 hours), and 3 days after the surgical procedure. The main analysis consisted of comparing the groups (cardioplegic solution used) for the parameters: lactate, troponin, TNF-alpha, and IL-6. This comparison was conducted at three time points: T0 (preoperative), T1 (immediate postoperative), and T2 (3rd postoperative day). The comparative analysis of the standard and modified groups revealed no significant differences in interleukin-6, troponin, and TNF-alpha levels. Similarly, on the third postoperative day, there was no statistically significant difference between the two groups. Both the modified Del Nido cardioplegic solution with lactated Ringer's solution and the standard Plasmalyte® cardioplegic solution proved to be effective in terms of cardioprotection for adult patients undergoing valvular cardiac surgeries. The inflammatory response induced by exposure to the modified Del Nido cardioplegic solution, as assessed by lactate levels, showed no significant difference between the groups.