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Published on: December 11, 2017
Modified Del Nido Cardioplegia with a 1:4 Crystalloid-to-Blood Ratio Versus Blood-Based St. Thomas Cardioplegia in
Peter Jakub1, Tomáš Toporcer1, Matúš Marcin1
1Department of Heart Surgery, East Slovak Institute for Cardiovascular Diseases and Medical Faculty, Pavol Jozef Šafárik University, 04011 Košice, Slovakia.
The aim of this study was to retrospectively compare modified Del Nido and blood-based St. Thomas cardioplegia in adult patients undergoing isolated aortic valve replacement (AVR). This retrospective study included adult patients undergoing isolated AVR because of aortic valve stenosis between 2024 and 2025. Patients were stratified into blood-based St. Thomas and modified Del Nido groups. The main modification of the Del Nido solution was the adjustment of the crystalloid-to-blood ratio to 1:4. Preoperative and perioperative variables, as well as postoperative biomarkers, including high-sensitivity troponin I, creatine kinase (CK), CK-MB, and lactate, were analyzed. A total of 93 patients were included in the study (blood-based St. Thomas: n = 22; modified Del Nido: n = 71). No significant differences were observed in cardiopulmonary bypass time [98 min (IQR 84-110) vs. 90 min (IQR 74-110); p = 0.184] or aortic cross-clamp time [75 min (IQR 67-86) vs. 73 min (IQR 62-87); p = 0.345]. High-sensitivity troponin I levels at 24 h were numerically, but not statistically significantly, lower in the blood-based St. Thomas group [1961 ng/L (IQR 1367-4423) vs. 2819 ng/L (IQR 1698-5054); p = 0.240]. CK levels at 6 h were comparable between the groups [8.4 μkat/L (IQR 6.5-10.1) vs. 8.5 μkat/L (IQR 6.0-12.7); p = 0.632], as were CK-MB and lactate levels at all evaluated time points. In exploratory multivariable analyses adjusted for age, sex, preoperative LVEF, cardiopulmonary bypass time, and aortic cross-clamp time, cardioplegia type was not independently associated with postoperative biomarker levels. The less frequent dosing and membrane-stabilizing properties of modified Del Nido cardioplegia did not translate into statistically significant clinical or biochemical advantages in the setting of relatively short, isolated AVR procedures.
The aim of this study was to retrospectively compare modified Del Nido and blood-based St. Thomas cardioplegia in adult patients undergoing isolated aortic valve replacement (AVR). This retrospective study included adult patients undergoing isolated AVR because of aortic valve stenosis between 2024 and 2025. Patients were stratified into blood-based St. Thomas and modified Del Nido groups. The main modification of the Del Nido solution was the adjustment of the crystalloid-to-blood ratio to 1:4. Preoperative and perioperative variables, as well as postoperative biomarkers, including high-sensitivity troponin I, creatine kinase (CK), CK-MB, and lactate, were analyzed. A total of 93 patients were included in the study (blood-based St. Thomas: n = 22; modified Del Nido: n = 71). No significant differences were observed in cardiopulmonary bypass time [98 min (IQR 84-110) vs. 90 min (IQR 74-110); p = 0.184] or aortic cross-clamp time [75 min (IQR 67-86) vs. 73 min (IQR 62-87); p = 0.345]. High-sensitivity troponin I levels at 24 h were numerically, but not statistically significantly, lower in the blood-based St. Thomas group [1961 ng/L (IQR 1367-4423) vs. 2819 ng/L (IQR 1698-5054); p = 0.240]. CK levels at 6 h were comparable between the groups [8.4 μkat/L (IQR 6.5-10.1) vs. 8.5 μkat/L (IQR 6.0-12.7); p = 0.632], as were CK-MB and lactate levels at all evaluated time points. In exploratory multivariable analyses adjusted for age, sex, preoperative LVEF, cardiopulmonary bypass time, and aortic cross-clamp time, cardioplegia type was not independently associated with postoperative biomarker levels. The less frequent dosing and membrane-stabilizing properties of modified Del Nido cardioplegia did not translate into statistically significant clinical or biochemical advantages in the setting of relatively short, isolated AVR procedures.
