Related Experiment Video
Updated: Apr 29, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Myocardial protection using del nido cardioplegia solution in adult reoperative aortic valve surgery
Robert A Sorabella1, Hiro Akashi, Halit Yerebakan
1Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, New York, New York.
Insights
Del Nido cardioplegia is safe and effective for adult reoperative aortic valve replacement, showing outcomes comparable to whole blood cardioplegia. This method requires significantly lower cardioplegia volumes for myocardial protection.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardioplegia Solutions
Background:
- Elevated intracellular calcium post-ischemia can cause irreversible myocyte injury.
- Del Nido cardioplegia was developed for pediatric patients with immature myocardium.
- Adults, especially in reoperative settings, may have different myocardial tolerance to calcium overload.
Purpose of the Study:
- To evaluate the safety and efficacy of Del Nido cardioplegia in adult reoperative aortic valve replacement.
- To compare outcomes between Del Nido cardioplegia and traditional whole blood cardioplegia in this population.
Main Methods:
- Retrospective review of adult patients undergoing isolated reoperative aortic valve replacement (2010-2012).
- Patients were divided into two groups: whole blood cardioplegia (WB) and Del Nido cardioplegia (DN).
- Data collected included demographics, comorbidities, operative variables, and postoperative outcomes.
Main Results:
- The Del Nido group required significantly lower total cardioplegia volume (1147.6 mL vs. 1985.4 mL) and retrograde dose.
- No significant differences were observed in cross-clamp time, bypass time, or postoperative complication rates.
- Patient outcomes were equivalent between the Del Nido and whole blood cardioplegia groups.
Conclusions:
- Del Nido cardioplegia provides equivalent postoperative outcomes to whole blood cardioplegia in adult reoperative aortic valve surgery.
- It achieves adequate myocardial protection using lower total and retrograde cardioplegia volumes.
- This suggests Del Nido cardioplegia is a viable and potentially more efficient option for this patient group.
Background And Aims:
The immediate postischemic period is marked by elevated intracellular calcium levels, which can lead to irreversible myocyte injury. Del Nido cardioplegia was developed for use in the pediatric population to address the inability of immature myocardium to tolerate high levels of intracellular calcium following cardiac surgery. Our aim in this study is to determine if this solution can be used safely and effectively in an adult, reoperative population.
Methods:
All patients undergoing isolated reoperative aortic valve replacement at our institution from 2010 to 2012 were retrospectively reviewed. Demographics, comorbidities, operative variables, postoperative complications, and patient outcomes were collected. Patients were divided into two groups based on cardioplegia strategy used: whole blood cardioplegia (WB, n = 61) and del Nido cardioplegia (DN, n = 52).
Results:
Mean age in the study was 73.4 ± 14.3 years and 86 patients were male (76.1%). Eighty-four patients had undergone prior coronary artery bypass graft (CABG) (74.3%). Patients in the DN group required significantly lower total volume of cardioplegia (1147.6 ± 447.2 mL DN vs. 1985.4 ± 691.1 mL WB, p < 0.001) and retrograde cardioplegia dose (279.3 ± 445.1 mL DN vs. 1341.2 ± 690.8 mL WB, p < 0.001). There were no differences in cross-clamp time, bypass time, postoperative complication rate, or patient outcomes between groups.
Conclusions:
Del Nido cardioplegia use in an adult, reoperative aortic valve population offers equivalent postoperative outcomes when compared with whole blood cardioplegia. In addition, use of del Nido solution requires lower total and retrograde cardioplegia volumes in order to achieve adequate myocardial protection.
