Abstract
PURPOSE: 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. METHODS: 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 (≥ 90 min). 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. RESULTS: 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). CONCLUSIONS: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-025-02033-3.