• Jessica Garcia-Suarez, Javier Garcia-Fernandez, Daniel Martinez Lopez, Leticia Reques, Sergio Sanz, Daniel Carballo, Carlos Esteban Martin, Victor Manuel Ospina, Susana Villar, Ana Martin, Maria Casado, Ana Villafranca, Ana Isabel Gonzalez, Santiago Serrano, and Alberto Forteza.
• Department of Anesthesiology and Critical Care, Puerta de Hierro University Hospital, Madrid, Spain. Electronic address: Jessicag.suarez@gmail.com.
• J. Thorac. Cardiovasc. Surg. 2023 Nov 1; 166 (5): 145814671458-1467.

ObjectiveThe study objective was to assess the benefits of del Nido cardioplegia compared with cold blood cardioplegia solution in terms of myocardial protection during adult cardiac surgery.MethodsA total of 474 adult patients undergoing coronary artery bypass grafting, heart valve surgery, thoracic aortic surgery, or combined procedures were randomized to the del Nido cardioplegia group (n = 234) or the cold blood cardioplegia solution group (n = 240) after provided informed consent. The primary end points assessed inotropic support requirements, severe cardiovascular events, and troponin trend within the first 48 hours of intensive care unit stay. Reperfusion arrhythmias, aortic crossclamp and cardiopulmonary bypass times, and other clinical perioperative variables were considered as secondary end points.ResultsNo statistically significant differences were found regarding postoperative inotropic support requirements or the incidence of severe cardiovascular events. The del Nido cardioplegia group showed a higher return to spontaneous sinus rhythm (P< .001), a lower number of defibrillation attempts (P< .001), and an earlier peak troponin value in the postoperative period. Peak blood glucose levels and intravenous insulin requirements were significantly lower in the del Nido cardioplegia group. We found no significant differences regarding aortic crossclamp or cardiopulmonary bypass time. We did observe a lower incidence of postoperative stroke in the del Nido cardioplegia group (2.6% vs 6.7%; P= .035).Conclusionsdel Nido cardioplegia can be used safely and with comparable outcomes compared with traditional cardioplegia solutions. Additional advantages over glycemic control, reperfusion arrhythmias, and its comfortable redosing interval make del Nido an interesting alternative for myocardial protection in adult cardiac surgery. A significant decrease in postoperative stroke will require further research to shed light on the results of this study. VIDEO ABSTRACT.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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