Myocardial protection in adult cardiac surgery: A comparative analysis of del nido versus St. Thomas cardioplegia

ABSTRACT Background: Myocardial protection is critical in cardiac surgery, and the choice of cardioplegia significantly influences the outcomes. Del Nido (DN) and St. Thomas (ST) cardioplegia are widely used, but their comparative efficacy in adult cardiac surgery remains under evaluation. This study compares DN and ST cardioplegia regarding postoperative circulatory support, left ventricular ejection fraction (LVEF), and hospital outcomes. Methods: This prospective study was conducted at the Department of Cardiovascular and Thoracic Surgery. Sixty-six adult patients undergoing coronary artery bypass grafting and valve surgeries were analyzed and equally divided into DN and ST groups. The key variables, including cardiopulmonary bypass (CPB) time, aortic cross-clamp (AXC) time, vasoactive inotropic score (VIS), mechanical ventilation duration, intensive care unit (ICU) stay, and hospital stay, were compared between the groups. Results: A total of 66 patients were analyzed, with 33 in each cardioplegia group. There were no statistically significant differences between the DN and ST groups in CPB time (173.3 ± 97.65 min vs. 132.9 ± 65.6 min, P > 0.05), AXC time (134.3 ± 68.3 min vs. 107 ± 55.8 min, P = 0.136), VIS (15.3 ± 8.6 vs. 12.18 ± 7.3, P = 0.211), mechanical ventilation duration (6.23 ± 2.29 h vs. 5.77 ± 1.78 h, P > 0.05), ICU stay (5.88 ± 2.03 days vs. 6.32 ± 2.36 days, P > 0.05), and total hospital stay (10.34 ± 3.13 days vs. 10.59 ± 3.01 days, P > 0.05). However, the DN group demonstrated significantly better postoperative LVEF (54.69% ±6.08% vs. 50.44 ± 6.56%, P = 0.006), suggesting superior myocardial preservation. In-hospital mortality was similar in both groups (3% each, P > 0.05). Conclusion: Both DN and ST cardioplegia provided comparable myocardial protection and clinical outcomes. However, DN was associated with a significantly higher postoperative LVEF, indicating potential advantages in myocardial preservation.