Buckberg versus Del Nido in isolated aortic valve replacement: a prospective, two-centre, randomized trial.

Summary

In 311 adults undergoing isolated AVR, Del Nido cardioplegia yielded higher spontaneous rhythm and less defibrillation for ventricular fibrillation after cross-clamp removal, as well as lower intraoperative glucose and insulin use, compared with Buckberg, while postoperative CK and hs-TnT peaks were similar.

Key Findings

• No difference in postoperative peak CK or hs-TnT between Buckberg and Del Nido.
• Del Nido increased spontaneous rhythm after cross-clamp removal (66.7% vs 43.1%) and reduced ventricular fibrillation requiring defibrillation (23.6% vs 49.7%).
• Del Nido had lower peak intraoperative glucose (128 vs 198 mg/dL) and less insulin administration (18.1% vs 51.0%).
• Total cardioplegia volume was higher with Del Nido (1000 mL vs 374.5 mL).

Clinical Implications

Del Nido cardioplegia may be preferred for isolated AVR to enhance rhythm stability and glycemic control and streamline workflow, though longer-term outcomes appear similar; centers may update perfusion/anesthesia protocols accordingly.

Limitations

• Limited to isolated AVR; not powered for long-term clinical endpoints.
• Blinding unlikely; potential performance bias on workflow-related outcomes.

Future Directions

Evaluate longer-term outcomes (e.g., myocardial function, arrhythmias, resource use) and generalizability to other adult cardiac procedures and higher-risk populations.