{
  "abstract": "Objectives To compare myocardial protection afforded by three single-dose cardioplegic solutions — Custodiol (HTK), del Nido (DN) and modified del Nido (MDN) — in adult elective cardiac surgery.Design Double-blind randomised controlled trial.Setting Tertiary hospital in southern Brazil.Participants 99 adults undergoing elective valve or coronary artery bypass surgery with cardiopulmonary bypass.Interventions Administration of HTK, DN or MDN solution during surgery.Main outcome measures High-sensitivity cardiac troponin T (hs-cTnT) at 0, 2, 12 and 24 hours postoperatively. Additionally, indirect measures of myocardial protection were compared, both laboratory and clinical, during intraoperative and postoperative periods.Results All solutions provided effective myocardial protection, with similar clinical and laboratory outcomes. DN was associated with significantly lower hs-cTnT at 2 hours (p=0.023) and fewer intraoperative transfusions (p=0.008). HTK patients had lower postoperative sodium and potassium levels (p=0.049 and p=0.002, respectively). Survival and major postoperative outcomes, including vasoactive or mechanical support, were similar across groups.Conclusions The three cardioplegic strategies showed comparable biochemical profiles of myocardial injury. DN was associated with lower early troponin release and reduced transfusion requirements, while HTK produced transient electrolyte shifts.Trial registration number ReBEC; RBR-7g5s66.",
  "authors": [
    {
      "affiliations": [
        "Postgraduate Program in Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil",
        "Department of Education and Research, Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, Brazil"
      ],
      "name": "Kathize Betti Lira"
    },
    {
      "affiliations": [
        "Postgraduate Program in Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil"
      ],
      "name": "Renan Senandes Delvaux"
    },
    {
      "affiliations": [
        "Postgraduate Program in Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil",
        "Department of Education and Research, Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, Brazil"
      ],
      "name": "Felipe Abatti Spadini"
    },
    {
      "affiliations": [
        "Department of Education and Research, Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, Brazil",
        "Health Technology Assessment Centre, Conceição Hospital Group, Porto Alegre, Brazil"
      ],
      "name": "Fernando Anschau"
    },
    {
      "affiliations": [
        "Department of Education and Research, Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, Brazil",
        "Health Technology Assessment Centre, Conceição Hospital Group, Porto Alegre, Brazil"
      ],
      "name": "Luciane Kopittke"
    },
    {
      "affiliations": [
        "Postgraduate Program in Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil",
        "Department of Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil"
      ],
      "name": "Juarez Rode"
    },
    {
      "affiliations": [
        "Postgraduate Program in Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil",
        "Department of Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil"
      ],
      "name": "Rafael Oliveira Ceron"
    },
    {
      "affiliations": [
        "Postgraduate Program in Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil",
        "Department of Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil"
      ],
      "name": "Rafael Antônio Widholzer Rey"
    },
    {
      "affiliations": [
        "Department of Education and Research, Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, Brazil",
        "Department of Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil"
      ],
      "name": "Estefania Inez Wittke"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil"
      ],
      "name": "Alfeu Roberto Rombaldi"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Division of Perfusion, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil"
      ],
      "name": "Alexsandro Rodrigues Oliveira"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Division of Perfusion, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil"
      ],
      "name": "Cristine Lunardi Rodrigues"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Division of Perfusion, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil"
      ],
      "name": "Carla Helena Pereira"
    },
    {
      "affiliations": [
        "Postgraduate Program in Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil",
        "Department of Education and Research, Postgraduate Program in Technology Assessment for the Brazilian National Health System, Conceição Hospital Group, Porto Alegre, Brazil",
        "Health Technology Assessment Centre, Conceição Hospital Group, Porto Alegre, Brazil",
        "Department of Cardiothoracic Surgery, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil"
      ],
      "name": "Adriana Silveira Almeida"
    }
  ],
  "title": "Comparison between three single-dose cardioplegic solutions in myocardial protection: Cardioplegia Trial – a double-blind randomised clinical trial",
  "uid": "42808891-f18c-588a-8628-5352c9a1570f"
}