A Decade of Re-operative Adult Cardiac Surgery with Del Nido Cardioplegia.

Authors

Preetha Pamidighantam, Michigan State University College of Human Medicine Medical Student
Carol Chen, Corewell Health West
Jessica Parker, Corewell Health West
Taylor Zimmer, Corewell Health West
Justin Fanning, Corewell Health West
Stephane Leung, Corewell Health West
Theodore Boeve, Corewell Health West
Marzia Leacche, Corewell Health West
John Heiser, Corewell Health West
Edward Murphy, Corewell Health West
Charles Willekes, Corewell Health West
Tomasz Timek, Corewell Health West

Document Type

Article

Publication Date

2-17-2026

Publication Title

The Journal of Thoracic and Cardiovascular Surgery

Abstract

OBJECTIVE: Evaluate safety and efficacy of del Nido (DN) and blood cardioplegia (BC) in adult re-operations over a 10-year period.

METHODS: Between April 2014 and March 2024, 696 adult patients underwent cardiac re-operations at our center with DN (N=325) or BC (N=369). Propensity-score matching by preoperative characteristics yielded 287 pairs. The primary outcome was myocardial protection, assessed by postoperative troponin T levels (cTnT) and left ventricular ejection fraction (LVEF). Secondary outcomes included 30-day complications and long-term survival.

RESULTS: Matched cohorts were balanced in demographics, risk factors, operative status, and surgical indication. DN was associated with shorter aortic cross-clamp (AXC) (121±60 vs 189±87 minutes, P< .0001) and cardiopulmonary bypass times (177±90 vs 256±111 minutes, P< .0001), and lower intra-operative glucose levels (176±43 vs 195±51 mg/dL, P< .0001). Thirty-day mortality, stroke, renal failure, atrial fibrillation, or mechanical circulatory support were similar between cohorts. Subgroup stratification by AXC time found lower cTnT with DN when AXC < 120 minutes (0.3[0.2,0.6] vs 0.4[0.3,0.7] ng/mL, P=.0257), but no difference at 121-180 or ≥180 minutes. Follow-up echocardiography was available in 91.1% at 2.8±2.7 years and revealed comparable LVEF (DN:52.3±13.2%, BC:52.5±13.1%; P=.8247). Nine-year survival was equivalent (63.2% vs 65.3%; P=.7913).

CONCLUSION: Del Nido cardioplegia offered comparable myocardial protection and perioperative outcomes overall, and equivalent long-term survival compared to blood cardioplegia in adult cardiac re-operations. However, AXC-stratified analysis revealed clinically relevant subgroup differences that warrant further investigation.

Recommended Citation

Pamidighantam P, Chen C, Parker J, Zimmer T, Fanning J, Leung S, et al [Boeve T, Leacche M, Heiser J, Murphy E, Willekes C, Timek T]. A decade of re-operative adult cardiac surgery with del nido cardioplegia. J Thorac Cardiovasc Surg. 2026. doi: 10.1016/j.jtcvs.2026.02.006. PMID: 41713701.

DOI

10.1016/j.jtcvs.2026.02.006

ISSN

1097-685X

PubMed ID

41713701