Key result
Del Nido cardioplegia is linked to ~50% fewer doses and better LVEF versus St. Thomas during MVR.
Why the study?
Comparative evidence regarding myocardial protective efficacy and clinical outcomes between del Nido and St. Thomas cardioplegia solutions in adult rheumatic mitral valve replacement remains limited.
Does del Nido cardioplegia solution improve myocardial protection and clinical outcomes compared to St. Thomas solution in adult patients undergoing mitral valve replacement for rheumatic heart disease?
Cohort (n=50)
Does del Nido cardioplegia solution improve myocardial protection and clinical outcomes compared to St. Thomas solution in adult patients undergoing mitral valve replacement for rheumatic heart disease?
Absolute Event Rate: 53.3% vs 45.3%
p-value: p=0.023
Del Nido cardioplegia provides comparable or superior myocardial protection with fewer doses and better postoperative LVEF compared to St. Thomas solution in adult rheumatic mitral valve replacement.
May support del Nido preference in mitral valve replacement; leaves open randomized confirmation of benefit.
Background Effective myocardial protection is essential for successful outcomes in open-heart surgery. Although both del Nido and St. Thomas cardioplegia solutions are widely used, comparative evidence in adult rheumatic mitral valve replacement remains limited. This study aimed to compare their myocardial protective efficacy and clinical outcomes. Methods A prospective comparative study was conducted between May 2022 and October 2024. Total 50 adult patients undergoing mitral valve replacement—20 with severe mitral regurgitation (MR) and 30 with severe mitral stenosis (MS) were included. Patients were divided into two groups based on cardioplegia type (del Nido or St. Thomas). Intraoperative parameters, postoperative left ventricular ejection fraction (LVEF), troponin I levels, inotropic and ventilatory support, and ICU/hospital stay were analysed. Results Baseline characteristics were comparable across groups. The mean number of cardioplegia doses was significantly lower in the del Nido group (1.6 ± 0.5 vs 3.2 ± 0.8; p < 0.001). Postoperative LVEF was better preserved with del Nido cardioplegia (MS: 53.3 ± 7.2% vs 45.3 ± 10.6%; p = 0.023). Troponin I levels at 6, 24, and 48 h were lower in the del Nido group, though not statistically significant. Patients receiving del Nido required less inotropic and ventilatory support, with shorter ICU and hospital stays. One in-hospital death occurred in the del Nido group due to sepsis. Conclusion Del Nido cardioplegia offers comparable or superior myocardial protection to St. Thomas solution in adult mitral valve replacement, with fewer interruptions, reduced dosing, and faster postoperative recovery.
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Shah et al. (2026) conducted a cohort in rheumatic mitral valve disease (n=50). del Nido cardioplegia solution vs. St. Thomas cardioplegia solution was evaluated on postoperative left ventricular ejection fraction in patients with mitral stenosis (p=0.023). Del Nido cardioplegia was associated with better preserved postoperative LVEF in patients with mitral stenosis compared to St. Thomas solution (53.3% vs 45.3%; p=0.023).
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