Effects of Del Nido and Terminal Warm Blood Cardioplegia on Myocardial Protection and Rhythm in Isolated CABG Patients


  • Kemal Karaarslan Sağlık Bilimleri University, Tepecik Education and Research Hospital, Department of Cardiovascular Surgery, Izmir, Turkey
  • Burcin Abud Sağlık Bilimleri University, Tepecik Education and Research Hospital, Department of Cardiovascular Surgery, Izmir, Turkey




del Nido cardioplegia, Coronary artery bypass grafting, Myocardial protection, Fibrilation


Objective: To investigate the effect of using del Nido cardioplegia+terminal hot-shot blood cardioplegia on myocardial protection and rhythm in isolated coronary bypass patients.

Material and methods: A total of 122 patients were given cold (+4-8C') del Nido cardioplegia antegrade and evaluated. Del Nido+terminal warm blood cardioplegia (TWBCP) was applied to 63 patients out of 122 patients, while del Nido cardioplegia alone was applied to the other 59 patients. The preoperative and postoperative data of the patients were recorded and compared.

Results: There was a significant statistical difference between the groups, in terms of volume with more cardioplegia in the del Nido+terminal warm blood cardioplegia group. Although there was no significant difference between cardiac arrest times in both groups, a statistically significant difference was found in the del Nido+terminal warm blood cardioplegia group in the starting to work time of the heart. No difference found between the groups regarding myocardial preservation.

Conclusions: We can add a return to spontaneous sinus rhythm to the advantages of terminal warm blood cardioplegia and del Nido cardioplegia in literature. We think it would be a good strategy to extend the safe ischemic time limit of del Nido to 120 minutes with a terminal warm blood cardioplegia. It seems that cardioplegia techniques that will be developed by adding the successful and superior results of crystalloid cardioplegia applications, such as single dose del Nido in various open heart surgery operations and the superior myocardial return effects of terminal warm blood cardioplegia, will be used routinely in the future.


Ad N, Holmes SD, Massimiano PS, et al. 2018. The use of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial J Thorac Cardiovasc Surg. 155:1011-1018.

Bigelow WG, Lindsay WK, Greenwood WF. 1950. Hypothermia; its possible role in cardiac surgery: an investigation of factors governing survival in dogs at low body temperatures. Ann Surg. 132:849-866.

Buckberg GD, Athanasuleas CL. 2016. Cardioplegia: solution or strategies? Eur J Cardiothorac Surg. 50:787-791.

Cagdas C, M, Yuksel A. 2020. The Use of del Nido Cardioplegia for Myocardial Protection in Isolated Coronary Artery Bypass Surgery. Heart Lung Circ. 29:301-307.

Caputo M, Dihmis WC, Bryan AJ, et al. 1998. Warm blood byperkalemic reperfusion (’hot shot’) prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 13:559-564.

Govindapillai A, Hua R, Rose R, et al. 2013. Protecting the aged heart during cardiac surgery: use of del Nido cardioplegia provides superior functional recovery in isolated hearts. J Thorac Cardiovasc Surg. 146:940-948.

Hamad R, Nguyen A, Laliberte´ E´, et al. 2017. Comparison of del Nido cardioplegia with blood cardioplegia in adult combined surgery. Innovations (Phila). 12:356-362.

Kim K, Ball C, Grady P, et al. 2014. Use of del Nido Cardioplegia for Adult Cardiac Surgery at the Cleveland Clinic: Perfusion Implications. J Extra Corpor Technol. 46:317-323.

Li Y, Lin H, Zhao Y, et al. 2018. Del Nido cardioplegia for myocardial protection in adult cardiac surgery: a systematic review and meta-analysis. ASAIO J. 64:360-367.

Matte GS, del Nido PJ. 2012. History and use of del Nido cardioplegia solution at Boston Children’s Hospital. J Extra Corpor Technol. 44:98-103.

Melrose DG, Dieger DB, Bentall HH, et al. 1955. Elective cardiac arrest. Lancet. 269:21-22.

Nakao M, Morita K, Shinohara G, et al. 2020. Superior restoration of left ventricular performance after prolonged single-dose del Nido cardioplegia in conjunction with terminal warm blood cardioplegic reperfusion. J Thorac Cardiovasc Surg. 5223:33300-33306.

O’Blenes SB, Friesen CH, Ali A, et al. 2011. Protecting the aged heart during cardiac surgery: The potential benefits of del Nido cardioplegia. J Thorac Cardiovasc Surg. 141:762-770.

O’Brien JD, Howlett SE, Burton HJ, et al. 2009. Pediatric cardioplegia strategy results in enhanced calcium metabolism and lower serum troponin T. Ann Thorac Surg. 87:1517-1523.

Pieri M, Belletti A, Monaco F, et al. 2016. Outcome of cardiac surgery in patients with low preoperative ejection fraction. BMC Anesthesiol. 16:97.

Ramanathan R, Parrish DW, Armour TK, et al. 2015. Use of del Nido cardioplegia in adult cardiac surgery. Thorac Cardiovasc Surg. 63:624-627.

Ristagno G, Wang T, Tang W, et al. 2008. High-energy defibrillation impairs myocyte contractility and intracellular calcium dynamics. Crit Care Med. 36:422-427.

Schutz A, Zhang Q, Bertapelle K, et al. 2020. Del Nido cardioplegia in coronary surgery: a propensity-matched analysis. Interact Cardiovasc Thorac Surg. May;30:699-705.

Scott T, Swanevelder J. 2009. Perioperative myocardial protection. Continuing Education in Anaesthesia Critical Care & Pain. 9: 97–101.

Siddiqi S, Blackstone EH, Bakaeen FG. 2018. Bretschneider and del Nido solutions: Are they safe for coronary artery bypass grafting? If so, how should we use them? J Card Surg 33:229-234.

Teoh KH, Christakis GT, Weisel RD, et al. 1986. Accelerated myocardial metabolic recovery with terminal warm blood cardioplegia. J Thorac Cardiovasc Surg. 91:888-895.

Timek T, Willekes C, Hulme O, et al. 2016. Propensity matched analysis of del Nido cardioplegia in adult coronary artery bypass grafting: initial experience with 100 consecutive patients. Ann Thorac Surg. 101:2237-2241.

Volpi S, Ali JM, De Silva R. 2019. Does the use of a hot-shot lead to improved outcomes following adult cardiac surgery? Interact Cardiovasc Thorac Surg. 28:473-477.

Yerebakan H, Sorabella RA, Najjar M, et al. 2014. Del Nido Cardioplegia can be safely administered in high-risk coronary artery bypass grafting surgery after acute myocardial infarction: a propensity matched comparison. J Cardiothorac Surg. 30:141.



How to Cite

karaarslan, kemal, & Abud, B. (2021). Effects of Del Nido and Terminal Warm Blood Cardioplegia on Myocardial Protection and Rhythm in Isolated CABG Patients. The Heart Surgery Forum, 24(5), E808-E813. https://doi.org/10.1532/hsf.4103