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Comparative Study of Single Dose Delnido Cardioplegia Versu Multi Dose Blood Cardioplegia in Coronary Artery Bypass Grafting [CABG]

This comparative study of 30 adult CABG patients demonstrates that single-dose Delnido cardioplegia offers effective myocardial protection with superior intraoperative efficiency and better postoperative outcomes, including improved renal function and shorter recovery times, compared to multidose blood cardioplegia.

Original authors: G Kiruthikasri, R Awasthy

Published 2026-10-12

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CC BY 4.0

Original authors: G Kiruthikasri, R Awasthy

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Heart surgery often requires a moment of stillness. To repair the blocked pipes that feed the heart muscle, surgeons must stop the heart from beating, allowing them to work on a motionless organ. To keep the heart muscle alive and healthy during this pause, they flood it with a special cold solution called cardioplegia. This liquid acts like a protective shield, slowing down the heart's metabolism so it can survive without its own blood supply. For decades, the standard approach has been to deliver this solution in several doses throughout the operation, much like refilling a tank to keep a car running during a long, difficult journey. However, a newer method has emerged that delivers the entire dose at once, relying on a single, powerful injection to protect the heart for the duration of the procedure.

A recent study from India set out to compare these two approaches in adult patients undergoing coronary artery bypass grafting, a common surgery that reroutes blood around blocked arteries. The researchers wanted to see if the single-dose method, known as Delnido cardioplegia, could offer better protection and faster recovery than the traditional multi-dose blood-based method. They recruited thirty adult patients scheduled for this surgery and divided them into two equal groups. Fifteen patients received the single-dose Delnido solution, while the other fifteen received the standard multi-dose blood mixture. The team then carefully tracked every step of the operation and the days that followed, measuring how long the heart was stopped, how long the patients needed breathing machines, and how well their kidneys and other organs recovered.

The results showed a clear difference between the two groups. Patients who received the single-dose Delnido cardioplegia spent less time on the heart-lung machine, which takes over the work of the heart and lungs during surgery, and less time with the aorta clamped off. In fact, the data indicated that the single-dose group moved through the operating room more efficiently, with the heart being stopped for a shorter period overall. This efficiency translated directly into the recovery room. Those who received the single dose were able to breathe on their own sooner after surgery, spent fewer days in the intensive care unit, and left the hospital faster than the group that received the repeated doses.

Beyond the timing of their recovery, the single-dose group also showed signs of better organ health. The researchers measured urine output and found that patients in the Delnido group produced more urine, a sign that their kidneys were functioning well. They also looked at levels of creatinine, a waste product in the blood that rises when kidneys are under stress. The single-dose group had lower levels of this waste product, suggesting their kidneys were under less strain during the surgery. While the study involved a relatively small number of patients, the patterns were consistent and statistically significant, pointing toward a smoother surgical experience and a quicker return to health for those receiving the single-dose treatment.

The study concludes that the single-dose Delnido cardioplegia is a safe and effective alternative to the traditional multi-dose method for adult heart surgery. By simplifying the process and reducing the need to interrupt the operation to give more doses, surgeons may be able to shorten the time the heart is under stress. The authors suggest that this approach could become a standard option for protecting the heart, though they note that larger studies with more patients would be needed to confirm these early findings. For now, the evidence suggests that a single, well-timed dose might be just as powerful, and perhaps even kinder to the body, than the repeated doses of the past.

Technical Summary: Comparative Study of Single Dose Delnido Cardioplegia Versus Multi Dose Blood Cardioplegia in CABG

Problem Statement

Coronary Artery Bypass Grafting (CABG) remains a critical intervention for coronary artery disease, yet myocardial injury during surgery remains a significant concern necessitating effective protection strategies. The choice of cardioplegia solution influences operative parameters and postoperative recovery. While multidose blood cardioplegia is the standard in adult cardiac surgery, it requires repeated administration, leading to frequent surgical interruptions, potentially increased cross-clamp times, and inconsistent myocardial protection. Conversely, single-dose Delnido cardioplegia, originally developed for pediatric surgery, offers prolonged protection (up to 90 minutes) via a single administration containing lidocaine and magnesium to stabilize cell membranes. Despite its growing popularity in adult surgery, there is a need to rigorously compare its efficacy against conventional multidose blood cardioplegia regarding intraoperative efficiency and postoperative organ function in adult patients.

Methodology

This prospective comparative study was conducted at the Department of Cardiothoracic Surgery, Sree Balaji Medical College and Hospital (Bharath Institute of Higher Education and Research).

Study Population: 30 adult patients undergoing elective, isolated CABG with cardiopulmonary bypass (CPB).
Exclusion Criteria: Emergency surgery, redo CABG, combined cardiac procedures, and significant pre-existing renal dysfunction.
Group Allocation: Patients were equally divided into two groups ( $n=15$ $n = 15$ per group):
- Group A: Received single-dose Delnido cardioplegia.
- Group B: Received multidose blood cardioplegia (4:1 blood-to-crystalloid ratio).
Intervention: Myocardial protection was administered according to group assignment. Group A received a single dose (with additional dosing only if clinically required), while Group B received repeated doses at appropriate intervals during the cross-clamp period.
Data Collection: Preoperative, intraoperative, and postoperative parameters were recorded using a structured proforma.
Parameters Assessed:
- Intraoperative: Cardiopulmonary bypass (CPB) time, aortic cross-clamp time, urine output.
- Postoperative: Duration of mechanical ventilation, ICU stay, hospital stay, and peak serum creatinine.
Statistical Analysis: Data were analyzed using SPSS. Continuous variables were expressed as mean ± standard deviation. A p-value of <0.05 was considered statistically significant.

Key Results

The study reported statistically significant differences ( $p<0.001$ ) across all measured intraoperative and postoperative parameters, favoring the Delnido group.

1. Intraoperative Outcomes:

CPB Time: 100% of the Delnido group fell into the lower time category (90–121 mins), whereas 80% of the Blood cardioplegia group fell into the higher category (122–140 mins).
Aortic Cross-Clamp Time: 93.3% of the Delnido group was in the lower time category (65–75 mins) compared to 0% in the Blood group.
Urine Output: 93.3% of the Delnido group demonstrated higher urine output (800–1200 ml) compared to the Blood group, where 100% fell into the lower output category (500–800 ml).

2. Postoperative Outcomes:

Mechanical Ventilation: 86.7% of the Delnido group required ventilation for 1–2 hours, compared to 0% in the Blood group (all required 2–4 hours).
ICU Stay: 93.3% of the Delnido group stayed 5–8 days, while 93.3% of the Blood group stayed 8–10 days.
Hospital Stay: 93.3% of the Delnido group had a stay of 1–14 days, whereas the Blood group had longer stays (100% in the 2–15 day category).
Renal Function (Serum Creatinine): The Delnido group showed lower peak serum creatinine levels (0.8–1.1 mg/dL in 93.3% of patients), indicating better renal preservation compared to the Blood group (where 93.8% fell in the 0.5–1.3 mg/dL range).

Key Contributions

Clinical Comparison: Provides a direct comparative analysis of single-dose Delnido versus multidose blood cardioplegia specifically within an adult CABG population, a demographic where Delnido was historically less utilized.
Operational Efficiency: Demonstrates that the single-dose strategy significantly reduces CPB and aortic cross-clamp times, likely due to the elimination of repeated administration interruptions.
Organ Protection: Correlates the Delnido strategy with improved postoperative renal function (lower creatinine, higher urine output) and faster recovery metrics (ventilation, ICU, and hospital stay).

Significance and Claims

The authors conclude that single-dose Delnido cardioplegia is a safe and effective alternative to multidose blood cardioplegia for adult CABG surgery. The study claims that Delnido offers:

Effective Myocardial Protection: Comparable or superior protection with fewer administrations.
Operational Advantages: Reduced surgical duration and simplified workflow by minimizing interruptions.
Improved Recovery: Favorable postoperative outcomes, particularly regarding renal function and reduced length of stay.

The paper explicitly notes that while the findings are promising, the study is limited by a small sample size ( $n=30$ ), single-center design, and a focus only on early postoperative outcomes. Consequently, the authors recommend larger, multicenter studies with long-term follow-up to validate these findings before widespread adoption.