Ringer Acetate versus Ringer Lactate Cardioplegia: A comparative study in Mitral Valve Surgery

Background: Ringer lactate has long been used in many surgical procedures as one of the isotonic solutions. However, with the development of Ringer acetate, it becomes the crystalloid of choice owing to its main metabolism in muscles unlike lactate which is mainly in liver, also it corrects acidosis more rapidly than lactate and it needs less 02 and produces less CO2. Ringer acetate has also a great utility during cardiovascular surgery with cardiopulmonary bypass. We compared efficacy and safety of Ringer acetate versus lactate in preparing cardioplegic solution during mitral valve surgery. Methods: 42 adult patients undergoing mitral valve replacement using CPB were randomly divided into two groups. Patients in group A received antegrade cold Ringer Acetate cardioplegic solution at a rate of 10 ml/kg followed after 20 minutes by 5ml/kg retrogradely in the coronary sinus. Patients in group B received cold Ringer Lactate cardioplegic solution in a similar regimen to group A. Results: Troponin I level from coronary sinus during reperfusion, was higher in group B than A (4.4±1.6 ng/ml & 3.4±1.49 ng/ml respectively) and after 4 & 24 hours postoperatively there was a significant increase in the serum Troponin I level in group B than in group A (p<0.05). Lactate in the coronary sinus was higher in group B than A during rewarming (2.8±1.9 ng/ml &1.6±1.8 ng/ml respectively). The serum level was always higher in group B than A in the postoperative period (P<0.05). There was no significant difference