Del Nido Cardioplegia As a Safe and Effective Method of Myocardial Protection in Adult Patients Undergoing Cardiac Surgery: a Single‑center Experience

Background: Del Nido (DN) cardioplegia is increasingly popular in adult cardiac surgery. It allegedly allows for up to 90 minutes of safe myocardial ischemia with a single dose.

Aims: We aimed to evaluate the benefits of DN cardioplegia.

Methods: Of the 2108 patients undergoing coronary or heart valve surgery with the use of cardiopulmonary bypass (CPB) between January 1, 2016, and September 30, 2017, 1236 (59%) received DN and 872 (41%) received cold blood cardioplegia. We retrospectively analyzed the collected data of all consecutive on‑pump patients to assess early mortality and postoperative troponin T release. A multivariable analysis of both outcomes adjusted for propensity to receive DN cardioplegia was performed.

Results: Patients protected with DN cardioplegia had longer CPB and aortic cross‑clamp times (P <0.001) but received fewer doses of cardioplegia. Median postoperative troponin T levels were higher in the DN‑cardioplegia than CB‑cardioplegia group: 0.324 ng/ml (interquartile range [IQR], 0.210-0.559 ng/ml) vs 0.285 ng/ml (IQR, 0.191-0.496 ng/ml); P = 0.01. However, when adjusted for the cross‑clamp time, propensity to receive DN cardioplegia, and other factors, DN cardioplegia was associated with lower postoperative troponin T levels. Early mortality rates did not differ between DN and CB cardioplegia (3.6% vs 3%; P = 0.54).

Conclusions: Del Nido cardioplegia is a safe and effective method of myocardial protection in adults. It allows for a longer redosing interval with a safety profile and mortality comparable to those for CB cardioplegia, as shown by lower troponin T release when corrected for the time of myocardial ischemia.