Effects of Del Nido and Blood Cardioplegia on Outcomes in Multiple Valve Surgery: A Retrospective Study

Background Cardioplegia plays a crucial role in myocardial protection during cardiac surgery, yet the optimal choice for multiple valve procedures remains controversial. This study evaluates the impact of Del Nido and blood cardioplegia on surgical outcomes, particularly focusing on mortality and cross-clamp duration. Methods This retrospective study analyzed adult patients (≥ 18 years) who underwent multiple valve surgery with cardiopulmonary bypass between 2019 and 2024. Patients were categorized into two groups: Del Nido cardioplegia (n = 55) and blood cardioplegia (n = 67). Primary outcomes included cross-clamp time, in-hospital mortality, ICU length of stay, and postoperative renal function. Statistical analyses utilized multivariable logistic regression and time-series analysis. Results Cross-clamp time was independently associated with mortality (p = 0.0003), with durations exceeding 100 minutes significantly increasing in-hospital mortality risk (p = 0.0058). While Del Nido cardioplegia showed a trend toward lower mortality compared to blood cardioplegia, the difference was borderline significant (p = 0.0546). No statistically significant differences were observed in ICU stay or postoperative renal function (p > 0.05). Conclusion Cross-clamp duration is a key determinant of mortality in multiple valve surgery. Del Nido cardioplegia may help reduce operative time; however, its long-term benefits remain uncertain. Further large-scale randomized trials are warranted to clarify its clinical advantages.