Operative data.

This study aimed to evaluate the safety and efficacy of a modified, bloodless Del Nido (DN) cardioplegia solution in patients undergoing isolated aortic valve replacement (AVR). A total of 370 patients who underwent isolated AVR between 2015 and 2022 were retrospectively analyzed. Patients were categorized into two groups based on the cardioplegia solution used: the bloodless DN group (N = 180) and the histidine-tryptophan-ketoglutarate (HTK) group (N = 190). To reduce selection bias and adjust for baseline differences, inverse probability of treatment weighting analysis was performed. There was no significant difference in in-hospital mortality between the two groups (HTK vs. DN: 1.2% vs. 0.9%, P = 0.554). However, the rate of spontaneous sinus rhythm restoration without the need for defibrillation following aortic cross-clamp release was significantly higher in the DN group (40.0% vs. 75.2%, P < 0.001). Additionally, the initial postoperative lactate level (3.0 ± 2.6 mmol/L vs. 2.2 ± 1.4 mmol/L, P = 0.002), and the incidence of low cardiac output syndrome (9.4% vs. 1.7%, P < 0.001) were significantly lower in the DN group compared to the HTK group. Other postoperative morbidities did not differ significantly between the groups. The modified bloodless Del Nido cardioplegia demonstrated favorable myocardial protection and early clinical outcomes compared to HTK solution in patients undergoing isolated AVR. These findings suggest that the bloodless Del Nido technique may be a viable alternative, although further validation in larger, prospective studies is warranted.

本研究旨在评估改良无血型Del Nido（DN）心脏停搏液在接受单纯主动脉瓣置换术（AVR）患者中的安全性与有效性。本研究对2015年至2022年间接受单纯AVR的370例患者开展回顾性分析。根据术中所使用的心脏停搏液类型，将患者分为两组：无血DN组（N=180）与组氨酸-色氨酸-酮戊二酸（HTK）组（N=190）。为减少选择偏倚并校正基线特征差异，本研究采用治疗加权逆概率分析进行统计学校正。两组患者的住院死亡率无显著统计学差异（HTK组：1.2%，DN组：0.9%，P=0.554）。然而，在主动脉阻断钳开放后无需除颤即可恢复自发窦性心律的比例，DN组显著高于HTK组（75.2% vs. 40.0%，P<0.001）。此外，与HTK组相比，DN组患者的术后初始乳酸水平（HTK组：3.0±2.6 mmol/L，DN组：2.2±1.4 mmol/L，P=0.002）以及低心排血量综合征的发生率（HTK组：9.4%，DN组：1.7%，P<0.001）均显著更低。两组其余术后并发症的发生率无显著统计学差异。相较于HTK溶液，改良无血型Del Nido心脏停搏液在接受单纯AVR的患者中展现出更优的心肌保护效果与早期临床结局。本研究结果提示，无血型Del Nido技术或可成为一种可行的临床替代方案，但仍需在更大规模的前瞻性研究中进一步验证其有效性。