Current evidence does not support superiority of one cardioplegia type over another, but stems from low-risk populations. Therefore, we compared outcomes of multimorbid, high-risk infective endocarditis (IE) patients receiving Custodiol®crystalloid or Calafiore blood cardioplegia during cardiac surgery. We retrospectively analyzed 553 patients (mean EuroScore II 22.7 ± 21.1) who underwent surgery for IE between 2009 and 2023 and received either cold crystalloid (Custodiol®, n = 335) or warm blood (Calafiore, n = 218) cardioplegia. The primary endpoint was 1-year mortality. Secondary endpoints included 30-day mortality, postoperative stroke, and new-onset dialysis. Propensity score matching (1:1, 14 covariates) resulted in 175 matched pairs. Statistical analysis included nonparametric and exact tests. In the overall cohort, patients receiving Custodiol® were higher risk and had higher mortality and morbidity. After matching, there was no significant difference in 1-year mortality between patients receiving Custodiol® and Calafiore (37.1% vs. 28.6%, p = 0.09). 30-day mortality trended to be lower in the Calafiore group without reaching statistical significance (22.9% vs. 14.9%, p = 0.057). However, stroke was less frequent (4.6% vs. 10.9%, p = 0.029), ICU stay was shorter (3[1-8] vs. 6[3-12.5] days, p < 0.001) and postoperative dialysis was numerically less common (13.7 vs. 20.6%, p = 0.091). These differences were most evident in procedures with shorter cross-clamp times, such as isolated mitral or aortic valve surgery, where mortality and recovery parameters consistently favored Calafiore. In high-risk endocarditis patients warm blood cardioplegia may be superior to cold crystalloid, although differences did not reach statistical significance. However, propensity matching may not have accounted for all differences, which warrants further discussion and investigation.

ObjectiveMyocardial protection research in adult cardiac surgery has increasingly examined single dose del Nido cardioplegia alongside conventional multidose blood cardioplegia. Using a scientometric modeling approach, this study aims to quantitatively evaluate whether the thematic emphasis of this literature has expanded over time from pure protection efficacy toward workflow-related procedural parameters.MethodsA total of 269 focal publications published between 2000 and 2025, representing a 25-years analytical period, comparing myocardial protection strategies were analyzed using the Web of Science (WoS) Core Collection database. Author keywords were stratified by two independent reviewers into two predefined conceptual domains: the Efficacy Domain, including terms related to physiological myocardial protection (e.g., troponin, ischemia-reperfusion), and the Efficiency Domain, including workflow-related procedural parameters (e.g., cross-clamp time, minimally invasive surgery, single dose cardioplegia), with strong inter-rater agreement (Cohen's κ = 0.92). Temporal trends were quantified using weighted linear regression models to evaluate the association between publication year and the relative prominence of efficiency-domain terminology.ResultsAnalysis of publication volume reveals a marked increase in literature, particularly from 2018 onwards. Keyword network analysis identified three distinct clusters: (1) traditional blood cardioplegia, (2) modern adult surgery/minimally invasive applications, and (3) evidence synthesis. Trend analysis demonstrated a statistically significant increase in the prominence of efficiency-related terms over the study period (β = 0.027 per year, 95% CI 0.014-0.040; p for trend <0.01).ConclusionThis scientometric analysis indicates an increasing emphasis in the literature on workflow-related procedural parameters in the evaluation of cardioplegia strategies in adult cardiac surgery. Contemporary studies increasingly report workflow-related procedural parameters such as uninterrupted surgical flow, cross-clamp time, and compatibility with minimally invasive or robotic techniques in the evaluation of cardioplegia strategies. These findings indicate an expanding investigational emphasis within the literature toward workflow-related procedural parameters alongside traditional efficacy and safety-oriented outcomes.

Objectives: Myocardial ischemia-reperfusion injury remains a major source of morbidity in cardiac surgery, and novel strategies for cardioprotection are needed.Preoperative dietary modulation has been proposed as a feasible approach to enhance myocardial resilience.This study investigated the effects of preoperative plant-based versus animal-based diets (ABD) on myocardial protection in a rat model of cardioplegic arrest, with emphasis on apoptosis, oxidative stress, and stress response markers. Materials and Methods:Sixteen male Wistar albino rats were initially randomized to receive either a plant-based diet (PBD) (soy protein, palm oil) or an ABD (casein, milk fat) for 12 weeks.Due to peri-experimental losses, final analyses were performed on 6 rats in the PBD group and on 7 rats in the ABD group.At the end of the feeding period, rats underwent a standardized cardioplegic arrest induced by St. Thomas II crystalloid solution, resulting in 10 minutes of ischemia; blood cardioplegia was then administered prior to tissue harvesting.Left ventricular tissues were harvested for biochemical analysis.Bcl-2 and Bax, glutathione (GSH), protein carbonyls and malondialdehyde (MDA), and heat

Optimal myocardial protection remains challenging in emergency coronary revascularization, especially in patients with severely reduced left ventricular function. Contemporary cardioplegia strategies aim to limit ischemia&ndash;reperfusion injury and enhance postoperative ventricular recovery. The aim of this study was to compare operative parameters, early postoperative outcomes, and myocardial functional recovery between single-dose Del Nido cardioplegia and conventional blood cardioplegia in adults with left ventricular ejection fraction (LVEF) &le;40% undergoing emergency isolated coronary artery bypass grafting (CABG). This retrospective study included 150 consecutive patients with left ventricular ejection fraction (LVEF) &le;40% who underwent emergency isolated CABG between 2022 and 2024. Patients were assigned to either the Del Nido group (n=80) or the conventional blood cardioplegia group (n=70). Demographics, operative variables, postoperative complications, ventricular function changes, and short-term mortality were analyzed. Myocardial recovery was assessed using &Delta;EF (postoperative minus preoperative LVEF).&nbsp; . The Del Nido group demonstrated significantly shorter aortic cross-clamp and cardiopulmonary bypass times and required less intraoperative defibrillation. The incidence of postoperative atrial fibrillation was lower in the Del Nido group (18%) compared with conventional blood cardioplegia (29%). Improvement in ventricular function was greater with Del Nido (&Delta;EF +5.8&plusmn;2.1%) than with blood cardioplegia (+3.2&plusmn;2.4%). Rates of stroke, perioperative myocardial infarction, and early mortality were comparable between groups. Single-dose Del Nido cardioplegia provides effective and safe myocardial protection in emergency low-EF CABG, offering improved operative efficiency and superior early ventricular recovery without increasing perioperative complications.

Patients undergoing cardiac surgery frequently suffer impaired myocardial redox protection during cardiopulmonary bypass (CPB), with elderly patients facing higher complication risks. We investigated the redox-protective effects of blood versus del Nido cardioplegia on systemic redox homeostasis, stratified by age, in patients undergoing coronary bypass and isolated valve surgery. Systemic redox biomarkers were assessed with immunochemical and spectrophotometric methods in patients stratified by cardioplegia type (blood vs. del Nido) and age (< 60 vs. ≥60 years). Redox biomarkers such as MnSOD, catalase, total thiol, PCO, AOPP, LOOH, GPxA, and AGE were analyzed in blood samples of postoperative CPB patients (n = 60). MnSOD levels were significantly higher with blood cardioplegia, indicating increased mitochondrial oxidative stress, whereas lower levels in the del Nido group suggested improved redox balance. Catalase activity appeared higher in the del Nido group, potentially influenced by outliers. Total thiol levels varied significantly among younger patients: those receiving blood cardioplegia had higher thiol concentrations, suggesting a more robust antioxidant buffer. No significant differences were observed regarding PCO, AOPP, LOOH, GPxA, or AGE between groups. This analysis highlights MnSOD as the most reliable biomarker for differentiating cardioplegia strategies. Lower MnSOD levels in the del Nido group support its superior redox-protective effects, which are particularly relevant for reducing surgical complications in elderly patients undergoing cardiac surgery.

A decade of reoperative adult cardiac surgery with Del Nido cardioplegia.

To compare the effects of intermittent classical blood cardioplegia and single-dose modified Del Nido cardioplegia on postoperative serum lactate levels and extubation time in patients undergoing coronary artery bypass grafts (CABG). An observational study. Place and Duration of the Study:Department of Cardiovascular Surgery, Faculty of Medicine, Kastamonu University, Kastamonu, Turkiye, from 2020 to September 2023. Forty patients who underwent CABG between 2020 and 2023 were randomly divided into two groups. Group 1 formed 20 patients who received intermittent classical blood cardioplegia, and Group 2 formed 20 patients who received single-dose modified Del Nido cardioplegia. Demographic data, bypassed vessels, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, postoperative drainage, inotrope required and extubation time, glomerular filtration rate (GFR), and serum lactate levels were recorded 2 hours after surgery. The Shapiro-Wilk test was utilised to evaluate the normality of data distribution. The Mann-Whitney U test was employed for variables that did not follow a normal distribution, whereas normally distributed variables were analysed using the independent samples t-test. Additionally, the chi-square test was applied to compare categorical variables across groups. No statistically significant differences were detected between the groups with respect to demographic data, ACC time, CPB time, bypassed vessels, postoperative drainage, inotrope requirement, or GFR. Postoperatively, lactate levels were statistically lower in Group 2 than in Group 1, and extubation time was statistically shorter in Group 2 than in Group 1 (p <0.001). Modified Del Nido cardioplegia reduces postoperative lactate levels and extubation time. Therefore, modified Del Nido cardioplegia provides better patient stability and myocardial protection than the classical blood cardioplegia after CABG. Atherosclerosis, Coronary artery bypass grafting, Mortality.

Introduction: Ischemic preconditioning (IP) is a method that may help protect the human heart from injury during cardiac surgery. It is believed that IP prepares the heart for upcoming prolonged ischemia by activating local protective mechanisms. Objective: This prospective study aims to evaluate the degree of myocardial protection offered by IP compared to standard cold blood cardioplegia (CBC). Materials and Methods: Fifty patients with stable angina and coronary artery disease (CAD) scheduled for coronary artery bypass grafting (CABG) were randomized into two groups: IP (n=25) and control (n=25). In the IP group, two cycles of 2-minute ischemia followed by 3-minute reperfusion were applied before aortic cross-clamping. Blood samples were collected through a central venous catheter to measure creatine kinase-MB fraction (CK-MB), creatine phosphokinase (CPK), cardiac troponin I (cTnI), and lactate dehydrogenase (LDH). Postoperative cardiac rhythm was also monitored. Results: The release of cTnI and lactate was significantly lower in the IP group compared to the control group (cTnI p &lt; 0.0001, CK-MB p = 0.005, CPK p = 0.005). However, there was no significant difference in LDH levels between the groups (p = 0.264). The need for defibrillation after cardiac arrest was lower in the IP group compared to the control group (18% vs. 40%). Conclusion: The role of IP in cardiac surgery remains uncertain. However, compared to CBC alone in low-risk CABG patients, IP as an adjunct to CBC reduced levels of cTnI, CK-MB, and CPK, and was associated with a lower incidence of postoperative atrial fibrillation.

IntroductionContinuous retrograde cardioplegia worsens surgeon's vision while performing distal anastomosis in coronary artery bypass grafting operations. We investigated whether intermittent retrograde cardioplegia, which provides a bloodless surgical field by interrupting cardioplegia flow during distal anastomosis, poses a disadvantage in terms of myocardial protection.MethodsThis retrospective study was conducted in two different heart centres between January 2013 and July 2023. A total of 234 patients who underwent ≥2 target vessel revascularization under cardiopulmonary bypass were examined. Isothermic, potassium-enriched blood cardioplegia was used and induction was performed antegrade in all patients. In addition to antegrade, we routinely gave retrograde cardioplegia. Retrograde cardioplegia was applied continuously with the force of gravity in the continuous group (n = 167), and intermittently with pressure in the intermittent group (n = 167).ResultsThe volume of cardioplegia solution administered was significantly higher in the intermittent group compared to the continuous group (4070 ± 760mL vs 3190 ± 575mL; p = 0.001). However, no significant differences were observed between the groups regarding postoperative clinical outcomes or early mortality rates.ConclusionsIntermittent retrograde cardioplegia offers superior operative conditions by ensuring a bloodless surgical field and improved procedural comfort, while maintaining equivalent efficacy in myocardial protection compared with the continuous method.

Del Nido Cardioplegia (DNC) is widely used in nontransplant cardiac surgery, but its role as a preservation solution in cardiac transplantation is unclear. We conducted a retrospective observational study of 61 patients undergoing heart transplant between January 2015 and December 2023. Only recipients with locally procured donor hearts were included. Recipients were grouped according to the type of preservative solution: DNC (n = 33) versus control (crystalloid + cold blood cardioplegia; n = 28). Patients in the DNC group were older and more frequently received hearts from donation after circulatory death. The Del Nido Cardioplegia group had lower troponin-T release at 48 hours (median [interquartile range {IQR}]: 1,062 [820] vs. 700 [345]; p = 0.03). Compared with the DNC, control group was related with longer ischemic (median [IQR]: 65 [55-83] vs. 80 [70.2-92.7] minutes; p = 0.002) and bypass times (median [IQR]: 90 [73.5-112] vs. 108 [97-118] minutes; p = 0.001). On-pump blood glucose levels and need for electrical defibrillation were lower with DNC. In heart transplantation using locally procured grafts, DNC appears to be a feasible preservation strategy. Del Nido Cardioplegia was associated with shorter operative times and lower troponin release in our initial experience. Further studies should be performed to confirm these promising results.

Custodial-HTK (Histidine-Tryptophan- Ketoglutarate) solution and blood cardioplegia are both established methods for myocardial protection during cardiac surgery. However, their utility in patients undergoing complex cardiac surgery is not extensively study. This study compares clinical outcomes between patients receiving Custodial-HTK and blood cardioplegia in one of the tertiary Malaysian cardiac center. We retrospectively analyzed data from 79 patients who underwent elective, on-pump, crossclamp cardiac surgeries at Faculty of Medicine, Universiti Teknologi MARA (UiTM) from August 2022 to July 2023. Patients undergoing emergency procedures, off-pump, or incomplete records were excluded. Patients receiving Custodial-HTK were typically those with impaired LVEF or requiring complex surgeries. Custodial-HTK was used in 12% of cases. These patients had slightly higher mean age (61.9 ± 7.6 vs. 59.9 ± 8.8 years) and higher mean EuroSCORE II, although the latter was not statistically significant (p = 0.115). Comorbidities including diabetes, hypertension, stroke, and renal disease were comparable between groups. The Custodial group showed significantly lower mean LVEF (43.7 ± 14.7%) and greater use of pre-induction intra-aortic balloon pump (IABP) (20%). Complex procedures were more frequent (50%), with longer mean cardiopulmonary bypass (181.7 ± 65.1 minutes) and cross-clamp durations (131.3 ± 50.4 minutes). Despite these differences, postoperative complication rates, ICU stay, total hospital stay, and 30-day mortality did not differ significantly between groups. Although patients receiving Custodial-HTK had higher surgical complexity and poorer baseline cardiac function, postoperative outcomes were within acceptable clinical range to the blood cardioplegia group. These findings support the use of Custodial-HTK as a safe and effective alternative in high-risk cardiac surgery patients.

Research regarding Custodiol's safety in minimally invasive mitral valve repair remains limited in Asian populations. We compared Custodiol in minimally invasive mitral valve repair to repetitive cold blood cardioplegia in open mitral valve repair. We retrospectively evaluated 98 consecutive patients who underwent minimally invasive mitral valve repair with Custodiol and 70 consecutive patients who underwent open mitral valve repair with repetitive cold blood cardioplegia at our institution between January 2015 and December 2024. The primary endpoints were creatine kinase-myocardial band (MB) levels and left ventricular ejection fraction determined by echocardiography pre- and post-surgery. Maximum creatine kinase-MB levels within 48 h post-surgery were significantly lower in the minimally invasive group than in the open repair group, both in the overall cohort (45.0 vs. 60.7 U/L; p <0.001, respectively) and after excluding patients who underwent Maze procedure or pulmonary vein isolation (42.4 vs. 50.0 U/L; p = 0.009, respectively). Left ventricular ejection fraction pre- and post-surgery was comparable between the minimally invasive and open repair groups (72% vs. 69%; p = 0.426 and 59% vs. 60%; p = 0.204, respectively). Custodiol during minimally invasive mitral valve repair provides myocardial protection comparable to repetitive cold blood cardioplegia in open mitral valve repair.

Optimal myocardial protection (MP) remains critical in complex cardiac procedures, particularly double valve replacement (DVR) operations. This study aimed to compare the safety and efficacy of Custodiol versus cold blood cardioplegia (CBCP) for MP in DVR surgeries. A prospective, non-randomized controlled trial was conducted on 120 adult cases (aged 18-65years) undergoing elective DVR surgery. Patients were allocated to receive either Custodiol cardioplegia (group A, n = 60) or CBCP (group B, n = 60). Primary outcomes included postoperative cardiac enzyme levels, mechanical ventilation (MV) duration, and intensive care unit (ICU) stay. Secondary outcomes encompassed postoperative complications, mortality, and hospital stay (HS). Custodiol cardioplegia demonstrated superior operative efficiency with shorter aortic cross-clamp (ACC) time (98.5 ± 36.1 versus 116.1 ± 38.0min, p = 0.010). Creatine kinase-MB (CK-MB) levels were notably lower in the Custodiol group (11.90 ± 4.30 versus 13.60 ± 3.40 U/L, p = 0.017), while troponin I levels showed no substantial variation. Custodiol patients experienced shorter ICU stay (3.12 ± 1.10 versus 4.22 ± 1.20days, p < 0.001) and HS (8.24 ± 1.03 versus 13.39 ± 3.09days, p < 0.001). However, spontaneous ventricular fibrillation (VF) rates were higher with Custodiol (86.6% versus 26.6%, p < 0.001). Custodiol cardioplegia provides effective MP in DVR surgery with superior clinical outcomes, including reduced ischemic time and HS, despite increased VF rates. The online version contains supplementary material available at 10.1007/s12055-025-02126-z.

Background: Cardioplegia is essential for myocardial protection during cardiac surgery. The COVID-19 pandemic disrupted supply chains, affecting the availability of commercial cardioplegia solutions in Thailand and prompting institutions to modify their strategies. This study evaluates the distribution, selection, and adaptation of cardioplegia practices among Thai cardiac surgical centers during the pandemic. Methods: A nationwide survey was conducted in cardiac surgical centers performing ≥100 cases per year. Data on cardioplegia availability, usage, and preferences across different surgeries were collected via direct or telephone interviews with surgeons or perfusionists. Descriptive statistical analyses were applied. Results: St. Thomas-based cardioplegia remained the most widely used (95%), with 77.1% of institutions preparing custom formulations due to supply shortages. Histidine-tryptophan-ketoglutarate (HTK) was the second most used (76%), particularly in aortic and complex congenital surgeries, followed by del Nido cardioplegia (27%), often in modified formulations. Most centers (74%) used two to three cardioplegia solutions. Blood cardioplegia was preferred for coronary artery bypass grafting (89.2%) and valve procedures (78.4%), whereas HTK dominated in aortic (54.1%) and complex congenital surgeries (71.4%). Conclusion: Despite the pandemic, St. Thomas-based cardioplegia remained dominant in Thailand, with increasing reliance on HTK and modified del Nido cardioplegia. The widespread use of custom-made cardioplegia highlights the impact of supply chain disruptions. Post-pandemic studies are essential to evaluate long-term adaptations and refine myocardial protection strategies.

Background: Effective myocardial protection is essential during cardiac surgery to minimize ischemia-reperfusion injury and enhance postoperative recovery. Del Nido cardioplegia (DNC), initially developed for pediatric use, is increasingly utilized in adult patients due to its simplified single-dose protocol and prolonged myocardial arrest. Despite its widespread adoption, its comparative safety and efficacy versus traditional cardioplegic solutions—such as blood cardioplegia or St. Thomas solution—remains a subject of clinical debate. Methods: A systematic search was conducted in PubMed, Scopus, Embase, and Web of Science, following PRISMA guidelines, to identify studies published up to February 21, 2025. Studies comparing DNC with other cardioplegia types in cardiac surgery were included. Primary outcomes assessed were mechanical ventilation time, need for defibrillation, aortic cross-clamp time, length of hospital stay (LOS), and mortality. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model. Heterogeneity was evaluated using the I 2 statistic. Results: A total of 48 studies, encompassing 8,471 patients undergoing cardiac surgery, were included in the analysis. The use of DNC was associated with a significantly shorter duration of mechanical ventilation (MD: –1.37 hours; 95% CI: –2.54 to –0.21; p = 0.02) and a reduced need for defibrillation (RR: 0.67; 95% CI: 0.48 to 0.93; p = 0.02) compared to other cardioplegia solutions. There were no statistically significant differences in aortic cross-clamp time (MD: 6.05 minutes; 95% CI: –37.17 to 49.27; p = 0.78), LOS (MD: –0.19 days; 95% CI: –0.42 to 0.05; p = 0.12), or mortality (RR: 0.78; 95% CI: 0.49 to 1.25; p = 0.30) between DNC and other cardioplegia strategies. Conclusions: DNC appears to be a safe and efficient alternative for myocardial protection in both pediatric and adult cardiac surgery. Its practical advantages support its incorporation into standard surgical practice, particularly in settings seeking to streamline perfusion strategies. Additional studies are warranted to better define its optimal role and refine its use across diverse patient populations and surgical contexts.

Research on the safety and efficacy of del Nido cardioplegia in complex adult cardiac surgeries with prolonged aortic cross-clamp times remains limited. This study aimed to compare early clinical outcomes between the use of del Nido and blood cardioplegia in this patient cohort. A comprehensive database search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials through August 2024 to perform a meta-analysis comparing del Nido versus blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp time (≥ 90min). The primary endpoint was early mortality, and secondary endpoints included postoperative morbidity, left ventricular ejection fraction (LVEF), and cardiac enzymes. A random effects model was used to estimate the pooled effect size. Six studies met our eligibility criteria, including three propensity score-matched studies, with a total of 1916 patients. The incidence of early mortality was comparable between the del Nido and control groups, with a pooled odds ratio of 1.25 (95% confidence interval: 0.90, 1.25; p = 0.147). The incidence of postoperative stroke (p = 0.137), renal failure (p = 0.796), and atrial fibrillation (p = 0.449); postoperative LVEF (p = 0.379), and highest creatine kinase-myocardial band level (p = 0.151) were also similar. Highest troponin T level was significantly lower in the del Nido group with a standardized mean difference of - 0.22 (- 0.44, - 0.00; p = 0.049). In adult cardiac surgery with prolonged aortic cross-clamp, del Nido cardioplegia provides comparable myocardial protection and early mortality and morbidity rates compared to conventional blood cardioplegic solutions. The online version contains supplementary material available at 10.1007/s12055-025-02033-3.

Objective. To analyze the indications, early and mid-term outcomes of redo ascending aortic (AA) surgery, as well as risk factors of complications. Material and methods. We analyzed 1874 patients who underwent open AA surgery in our clinic between 01.01.2006 and 01.06.2023. Observational single-center retro-prospective study was devoted to evaluation of early and mid-term postoperative period. Exclusion criteria: unavailable postoperative follow-up data, emergency surgery, «non-aortic» indications for redo surgery. A group of 41 patients who underwent redo AA surgery was formed. Statistical analysis and searching for predictors of complications were performed using the PAST 4.0, integrated development environments Jupiter Notebook 5.7.8 and Google Colab, as well as the Python 3.8 programming language. Results. In-hospital mortality was 11.2% (n=5). The most common in-hospital complications were cardiovascular (32%, n=13) and respiratory failure (32%, n=13), cerebral circulatory disorders (15%, n=6). Risk factors of early postoperative complications were age, coronary artery disease, preoperative hemoglobin, aortic arch diameter, type of arterial cannulation and cardioplegia. Complete follow-up data were available for 36 (100%) patients (4—147 months). The annual and 5-year survival rates were 94.4% and 77.4%, respectively. Predictors of mortality in mid-term postoperative period were severity of chronic heart failure and age. Predictors of negative aortic remodeling were connective tissue disorders and patent false lumen. Conclusion. AA redo surgery is associated with high risk of complications and in-hospital mortality. Age, comorbidities and aortic arch diameter are non-modifiable risk factors of complications. Blood cardioplegia and cannulation of the right axillary artery can reduce the risks of cardiovascular failure and neurologic complications. Connective tissue disorders can justify more aggressive surgical approach.

Abstract Background Postoperative atrial fibrillation (POAF) is a common complication following coronary artery bypass grafting surgery (CABG) which increases morbidity and mortality. Numerous studies have compared the effect of warm blood cardioplegia (WBC) to cold blood cardioplegia (CBC) on the occurrence of post-CABG AF, with inconclusive outcomes. Methods We conducted a retrospective single-centre study involving 601 patients undergoing isolated CABG operated on from 2022 to 2024 at the Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals. A 1-to-1 propensity score matching (PSM) analysis was then used to control selection bias and confounding, creating a matched cohort of 480 patients (240 receiving CBC and 240 receiving WBC). The primary outcome was the incidence of POAF. A multivariable conditional logistic regression model was used to identify independent predictors of POAF in the matched cohort. Results In the propensity-matched cohort, there was no statistically significant difference in the incidence of POAF between the CBC group (65 patients, 27%) and the WBC group (53 patients, 22%) (p = 0.3). After adjusting for all baseline and procedural covariates in the multivariable analysis, the type of cardioplegia was not found to be an independent predictor of POAF (odds ratio (OR) 0.81, 95% confidence interval (CI) 0.48–1.38, p = 0.44). Advancing age was the sole independent predictor, with each additional year increasing the odds of developing POAF by 12% (OR 1.12, 95% CI 1.03–1.22, p = 0.008). Conclusions In this propensity-matched analysis, the choice between warm and cold blood cardioplegia did not significantly influence the risk of developing postoperative atrial fibrillation. The primary driver of POAF risk in this cohort was the non-modifiable factor of advancing age.

Coronary artery bypass grafting using cardiopulmonary bypass and cardioplegic arrest is an effective treatment for coronary artery disease. Research suggests supplementing the cardioplegia solution with propofol may be cardioprotective. Our aim was to compare the safety and efficacy of supplementing the cardioplegia solution with different doses of propofol in adults undergoing first-time surgery. A blinded, parallel group randomized controlled trial conducted in 3 hospitals in the United Kingdom compared a cardioplegia solution supplemented with high-dose propofol (concentration 12 μg/mL), low-dose propofol (concentration 6 μg/mL), and placebo (saline). Primary outcome was cardiac troponin T measurements over the first 48 hours after surgery. Participants were followed for 12 months. In total, 240 participants, median age 66 years, 90% male, were randomly allocated: 78 to high-dose propofol, 80 to low-dose propofol, and 82 to placebo. In total, 239 participants were included in the primary analysis. Geometric mean cardiac troponin release at 48 hours (95% confidence interval) was 145 ng/L (125-168), 162 ng/L (138-191), and 150 ng/L (125-180) in the high-dose propofol, low-dose propofol, and placebo groups, respectively (adjusted geometric mean ratio 1.06; 95% confidence interval, 0.97-1.15; P = .20, for pairwise comparisons between high- and low-dose propofol and between low-dose propofol and placebo). A total of 96 adverse events that prolonged the hospital stay or were life-threatening were reported (33, 26, and 37 in the high-dose propofol, low-dose propofol, and placebo groups, respectively), as well as 4 deaths (1 low-dose propofol group, 3 placebo group). Propofol supplementation of warm blood cardioplegia at both the lower and higher concentrations is safe, but there is no evidence to suggest either dose is cardioprotective.

ObjectıvesThe arterial switch operation (ASO) is the standard treatment for transposition of the great arteries (TGA), requiring robust myocardial protection due to the neonatal myocardium’s vulnerability to ischaemia. This study compares the myocardial protective efficacy of Custodiol, Del Nido, and cold intermittent blood cardioplegia in neonates undergoing ASO.MethodsWe retrospectively analysed 133 neonates with TGA undergoing ASO (2013-2024) at 4 Turkish centres, grouped by cardioplegia: cold blood (n = 47), Custodiol (n = 44), or Del Nido (n = 42). Outcomes included aortic cross-clamp and cardiopulmonary bypass times, troponin I, CK-MB, inotropic support, and ventilation duration.ResultsCustodiol and Del Nido had shorter cross-clamp (70.4 (8.5) vs 68.7 (7.9) vs 78.2 (9.1) minutes, P < .001) and bypass times (P = .004), lower troponin I (4.2 (1.3) vs 4.0 (1.5) vs 6.8 (1.9) ng/mL, P < .001), reduced inotropic needs (P < .001), and shorter ventilation/intensive care unit stays (P ≤ .010). Mortality was similar (P = .47).ConclusıonsCustodiol and Del Nido cardioplegia strategies provided favourable outcomes compared to cold blood cardioplegia in neonates undergoing ASO, with implications for optimizing myocardial protection protocols in this population.