Abstract 4372118: Expanding the Boundaries of Myocardial Protection — The Use of Del Nido Cardioplegia in Pediatric and Adult Cardiac Surgery Within a Controversial Landscape: A Systematic Review and Meta-Analysis of 8,471 Patients

Abstract

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.