Related Experiment Video
Updated: Oct 9, 2025
Heterotopic Cervical Heart Transplantation in Mice
Published on: August 25, 2015
Del Nido versus HTK cardioplegia for myocardial protection during adult complex valve surgery: a retrospective study
Lian Duan1, Guo-Huang Hu2, E Wang3
1Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China. duanlian_ida@csu.edu.cn.
Insights
Del Nido (DN) cardioplegia offers comparable myocardial protection to Histidine-tryptophan-ketoglutarate (HTK) in complex valve surgery, showing improved rhythm and cardiac output. DN is a safe alternative for high-risk cardiac procedures.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia Solutions
Background:
- Histidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are widely used for myocardial protection during cardiac surgery.
- Studies comparing DN and HTK in adult complex valve surgery, particularly with prolonged ischemia, are limited.
Purpose of the Study:
- To evaluate the efficacy and safety of del Nido (DN) cardioplegia compared to Histidine-tryptophan-ketoglutarate (HTK) in complex and high-risk adult valve surgery requiring long myocardial ischemia durations.
Main Methods:
- Retrospective analysis of adult patients undergoing complex valve surgery with expected ischemia >90 minutes.
- Propensity score matching was used to compare 73 pairs of patients who received either DN or HTK cardioplegia.
Main Results:
- Both DN and HTK provided satisfactory cardiac arrest and similar cardiac biomarker levels (cTnI, CK-MB).
- The DN group demonstrated a higher rate of return to spontaneous rhythm, lower severe postoperative arrhythmias, improved stroke volume and cardiac output, fewer transfusions, and shorter ICU stays.
- No significant differences were observed in inotrope usage, low cardiac output, morbidities, or mortality, though DN's advantages diminished with aortic clamping times >120 minutes.
Conclusions:
- Del Nido (DN) cardioplegia is a safe and effective alternative to HTK for complex valve surgery, offering potential benefits in postoperative recovery.
- Further prospective studies are warranted to confirm these findings and optimize the use of DN in extended cardiac procedures.
Background:
Histidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are intracellular-type and extracellular-type solution respectively, both can provide a long period of myocardial protection with single-dose infusion, but studies comparing the two are rare for adult cardiac surgery. This study aims to evaluate whether DN is suitable for cardioplegia in complex and high-risk valve surgery with long-term cardiac ischemia when compared with HTK.
Methods:
The perioperative records of adult patients infused with DN/HTK as a cardioplegic solution who underwent complex valve surgery with an expected myocardial ischaemic duration longer than 90 min between Oct 2018 and Oct 2019 were analysed retrospectively.
Results:
Of the 160 patients who received DN/HTK and underwent complex valve surgery, we propensity matched 73 pairs. Both groups achieved satisfactory cardiac arrest effects, and no significant difference was found in their cTnI and CK-MB levels within 12 to 72 h postoperatively. The DN group had a higher rate of return to spontaneous rhythm (0.88 v 0.52, P < 0.001), a lower frequency of postoperative severe arrythmias (12% v 26%, P = 0.036), a higher postoperative stroke volume (65 v 59 ml, P = 0.011) and a higher cardiac output (6.0 v 4.9 L/min, P = 0.007) as evaluated by echocardiography, fewer transfusions and shorter ICU stays (both P < 0.05). The two groups had similar inotrope usage and similar incidences of low cardiac output, morbidities and mortality. Subgroup analysis showed that when the aortic clamping time was greater than 120 min, the advantages of DN were weakened.
Conclusions:
DN can be safely applied to complex valve surgery, and it has a similar myocardial protection effect as HTK. Further prospective studies are required to verify these retrospective findings. Trial registration retrospectively registered.
