Del Nido versus Bretschneider HTK cardioplegia in adult aortic valve replacement: early clinical outcomes from a randomised trial.

Introduction: The search for the perfect cardioplegic solution continues. Although del Nido cardioplegia has achieved undeniable success in paediatric cardiac surgery, it has not gained comparable popularity in adult cases. Aim: This prospective randomised trial aimed to compare the cardioprotective properties and in-hospital clinical outcomes of two single-dose cardioplegic solutions: del Nido and Bretschneider HTK. Material and methods: One hundred adult patients scheduled for elective aortic valve replacement were randomly assigned to receive either del Nido or Bretschneider HTK cardioplegia. Details regarding cardiopulmonary bypass, the intra- and postoperative periods, and cardiac enzyme levels were collected. Results: Cardiac enzyme concentrations were similar between the two groups across all postoperative measurements. Only a correlation between cardiac markers and reperfusion time in the del Nido group was found. The Bretschneider HTK group showed a greater need for defibrillation after cross-clamp removal and lower pH values during cardiopulmonary bypass. No other significant differences in postoperative complications or laboratory results were observed. Conclusions: Del Nido and Bretschneider HTK cardioplegic solutions provide comparable cardioprotection and in-hospital clinical outcomes when used during elective aortic valve replacement. However, the use of Bretschneider HTK significantly increases the need for defibrillation and leads to greater intraoperative metabolic acidosis. Despite these findings, the cardiac enzyme levels in the postoperative period remain unaffected.