The del Nido versus cold blood cardioplegia in aortic valve replacement: A randomized trial

Abstract 1. Objectives To compare the cardioprotective efficacy of a solution that requires only a single infusion at the start of the ischemic duration versus a solution that requires multiple infusions. 2. Methods Aortic valve replacement (AVR) was done for 150 patients, who were randomized into the del Nido (DN) cardioplegia group or the cold blood (CB) cardioplegia group. The DN cardioplegia was delivered every 90 min, the CB cardioplegia was delivered every 20-30 minutes, or whenever cardiac activity was observed. The primary endpoints were: electrical cardiac activity during cross-clamp, ventricular fibrillation (VF) during reperfusion, postoperative troponin and creatine kinase (CK-MB isoenzyme) at 24 h and 48 h. 3. Results Electrical activity during cross-clamp occurred in 29 (39.7%) patients in the DN group vs 34 (45.3%) patients in the CB group; (adjusted P = 1.0). The number of procedures with VF after removing the cross-clamp was 41 (54.7%) in the CB group vs 17 (22.7%) in the DN group (adjusted P = .001; RR 2.41). Troponin values appeared to be lower in the DN group (median 223.10; IQR 168.35–364.77 pg/mL vs 285.5; 196.20-419.45 pg/mL at 24 h and 159.60; 125.42-217.20 pg/mL vs 201.60; 160.62–268.45 pg/mL at 48 h), and CK-MB (median 14.94; IQR 12.16–20.39 ng/mL vs 17.43; 13.66–22.43 ng/mL at 24 h and 6.19; 4.41–7.63 ng/mL vs 7.38; 4.74-10.20 ng/mL at 48 h), but no significance was found. 4. Conclusions The del Nido cardioplegia protocol is an acceptable alternative for cold blood cardioplegia in AVR patients.