Comparative Myocardial Protection Effects of Buckberg and del Nido in Mitral Valve Surgery: A Prospective Randomized Trial

Background: Myocardial protection during cardiopulmonary bypass requires essential techniques to preserve myocardial function and protect the myocardium from cellular damage. Objectives: This study aimed to investigate the efficacy of del Nido cardioplegia in mitral valve surgery compared to Buckberg solution.

Methods: All patients who underwent mitral valve surgery from April 2018 to December 2018 were recruited in the present trial. The patients were assigned randomly into del Nido and Buckberg groups. Trans-thoracic and trans-esophageal echocardiography were performed before and after the procedure to evaluate left ventricular ejection fraction, as the primary outcome.

Results: A total of 152 patients (77 in the del Nido group and 75 in the Buckberg group) were included in the final analysis. The mean age of the participants was 51.3 ± 13.4 years, and 55.3% of the patients were female. The two groups were comparable in terms of all baseline characteristics. The results also showed no significant difference between the two groups regarding pre-operative ejection fractions (P = 0.063). However, ventilation time and the mean length of ICU stay were higher in the Buckberg group (0.018 and 0.001, respectively). Moreover, the results indicated a more prominent reduction in left ventricular ejection fraction measured via trans-thoracic and trans-esophageal echocardiography in the Buckberg group compared to the del Nido group (13.7% versus 4.7%, P < 0.001 for trans-thoracic echocardiography).

Conclusions: Del Nido cardioplegia solution exerted beneficial effects on myocardial protection evaluated by echocardiography compared to Buckberg in adult patients with preserved ejection fraction undergoing mitral valve surgery.