Custodiol versus Del Nido cardioplegia in minimally invasive mitral valve repair–a propensity score-matched study

OBJECTIVES: Minimally invasive mitral valve repair (MIMVR) is the preferred approach to treat mitral regurgitation in specialized centres. Custodiol and Del Nido cardioplegia are widely used, yet direct comparative data on their efficacy and safety in this setting remain limited. This study investigated their efficacy and impact on early outcomes in a propensity-matched cohort. METHODS: We performed a single-centre, retrospective matched cohort study of 2490 patients undergoing minimally invasive mitral valve surgery between October 2014 and January 2025. After exclusions, 960 patients entered 1:1 propensity score matching based on risk factors, baseline characteristics and procedural parameters, yielding 778 matched cases treated with Custodiol or Del Nido cardioplegia. Perioperative dynamics of cardiac enzymes were evaluated as the primary outcome measure, along with an exploratory analysis on clinical outcomes. RESULTS: Del Nido cardioplegia was associated with lower postoperative creatine kinase and creatine kinase‑MB levels, most pronounced in the first 24 hours (P < .001). Del Nido yielded a lower inotrope score at 6 hours, higher perioperative sodium and fewer cardioversions for ventricular arrhythmia after declamping with fewer shocks required (all P < .001). Rates of major complications were similar between groups, and 30‑day mortality was 0% in both groups. CONCLUSIONS: Del Nido cardioplegia provided superior myocardial protection based on biomarker dynamics and a lower incidence of post-cross-clamp ventricular arrhythmia, while overall clinical outcomes remained comparable. It may therefore be considered the preferred single-dose cardioplegic solution for MIMVR.