{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T10:58:14Z","timestamp":1793444294705,"version":"4.5.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Del Nido cardioplegia has gained increasing popularity, evolving from its original use in paediatric and congenital heart surgery to widespread adoption in adult cardiac procedures. This review aims to summarize the composition, physiologic rationale, and clinical evidence supporting the use of alternative base solutions in del Nido cardioplegia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive literature review was conducted, analyzing experimental, observational, and randomized clinical studies that compared modified del Nido cardioplegia prepared with various alternative crystalloids.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Evidence demonstrates that del Nido cardioplegia prepared with alternative crystalloids including normal saline, lactated Ringer\u2019s, plain Ringer\u2019s, Isolyte S, Ionosteril, and whole blood provides myocardial protection and postoperative outcomes comparable with Plasma-Lyte A when appropriately buffered and supplemented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Alternative base solutions including normal saline, lactated Ringer\u2019s, plain Ringer\u2019s, Isolyte S, Ionosteril, and whole blood represent safe, effective, and cost-efficient substitutes for Plasma-Lyte A in del Nido cardioplegia. Standardized formulations and multicentre randomized studies are warranted to confirm long-term safety and support broader global implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivag019","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T12:19:09Z","timestamp":1768220349000},"source":"Crossref","is-referenced-by-count":1,"title":["Alternative Base Solutions for del Nido Cardioplegia: Composition, Rationale, and Clinical Evidence"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1166-1384","authenticated-orcid":false,"given":"Narongrit","family":"Kantathut","sequence":"first","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University , Bangkok 10400,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"2026012304315815700_ivag019-B1","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1051\/ject\/201244098","article-title":"History and use of del Nido cardioplegia solution at Boston children\u2019s hospital","volume":"44","author":"Matte","year":"2012","journal-title":"J Extra Corpor Technol"},{"key":"2026012304315815700_ivag019-B2","doi-asserted-by":"publisher","first-page":"697","DOI":"10.31480\/2330-4871\/199","article-title":"Physiology of cardiac arrest with del Nido cardioplegia","volume":"12","author":"Longacre","year":"2025","journal-title":"Transl Perioper Pain Med"},{"key":"2026012304315815700_ivag019-B3","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1177\/1556984519863718","article-title":"A systematic review and meta-analysis of del Nido versus conventional cardioplegia in adult cardiac surgery","volume":"14","author":"An","year":"2019","journal-title":"Innovations (Phila)"},{"key":"2026012304315815700_ivag019-B4","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1016\/j.hlc.2020.10.016","article-title":"Myocardial protection in adult cardiac surgery with del Nido versus blood cardioplegia: a systematic review and meta-analysis","volume":"30","author":"Misra","year":"2021","journal-title":"Heart Lung Circ"},{"key":"2026012304315815700_ivag019-B5","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1053\/j.jvca.2023.02.045","article-title":"Del Nido cardioplegia in adult cardiac surgery: meta-analysis of randomized clinical trials","volume":"37","author":"Fresilli","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026012304315815700_ivag019-B6","doi-asserted-by":"publisher","first-page":"522","DOI":"10.2459\/JCM.0000000000001506","article-title":"Del Nido versus blood cardioplegia in adult cardiac surgery: a metaanalysis","volume":"24","author":"Malvindi","year":"2023","journal-title":"J Cardiovasc Med (Hagerstown)"},{"key":"2026012304315815700_ivag019-B7","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1053\/j.semtcvs.2020.03.002","article-title":"Modified del Nido cardioplegia and its evaluation in a piglet model","volume":"33","author":"Nakao","year":"2021","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2026012304315815700_ivag019-B8","doi-asserted-by":"publisher","first-page":"793","DOI":"10.21470\/1678-9741-2020-0422","article-title":"Tepid modified del Nido cardioplegia in adults undergoing cardiac surgery: a propensity-matched analysis","volume":"37","author":"Sevuk","year":"2022","journal-title":"Braz J Cardiovasc Surg"},{"key":"2026012304315815700_ivag019-B9","doi-asserted-by":"publisher","first-page":"592","DOI":"10.25237\/revchilanestv52n6-06","article-title":"Comparative study between conventional crystalloid cardioplegic solution with modified del Nido cardioplegia in mitral valve regurgitation surgery","volume":"52","author":"Seleem","year":"2023","journal-title":"Rev Chil Anest"},{"key":"2026012304315815700_ivag019-B10","doi-asserted-by":"publisher","first-page":"67","DOI":"10.35810\/ects.v6i4.298","article-title":"Impact of modified del Nido versus traditional cold cardioplegia on myocardial protection in cardiac patients with a low ejection fraction","volume":"6","author":"Mostafa","year":"2024","journal-title":"Egypt. Cardiothoracic. Surg"},{"key":"2026012304315815700_ivag019-B11","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1051\/ject\/2024011","article-title":"Comparison of routine del Nido cardioplegia vs two types of modified del Nido cardioplegias for myocardial protection among patients undergoing coronary artery bypass grafting (CABG) surgeries: a randomized double-blind clinical trial","volume":"56","author":"Ali","year":"2024","journal-title":"J Extra Corpor Technol"},{"key":"2026012304315815700_ivag019-B12","doi-asserted-by":"publisher","first-page":"1366","DOI":"10.1111\/vsu.14278","article-title":"Saline-based modified del Nido cardioplegia versus multidose St Thomas cardioplegia in canine mitral valve repair: a randomized controlled trial","volume":"54","author":"Kurogochi","year":"2025","journal-title":"Vet Surg"},{"key":"2026012304315815700_ivag019-B13","first-page":"115","article-title":"Experience in the use of del Nido cardioplegia in Ramathibodi Hospital","volume":"100","author":"Kantathut","year":"2017","journal-title":"J Med Assoc Thai"},{"key":"2026012304315815700_ivag019-B14","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1051\/ject\/201951153","article-title":"Lactated Ringer\u2019s as a base solution for del Nido cardioplegia","volume":"51","author":"Kantathut","year":"2019","journal-title":"J Extra Corpor Technol"},{"key":"2026012304315815700_ivag019-B15","doi-asserted-by":"publisher","first-page":"e20220447","DOI":"10.21470\/1678-9741-2022-0447","article-title":"Comparison of single-dose cardioplegia in valvular heart surgery: lactated Ringer\u2019s-based del Nido vs. histidine-tryptophan-ketoglutarate cardioplegia solution","volume":"38","author":"Kantathut","year":"2023","journal-title":"Braz J Cardiovasc Surg"},{"key":"2026012304315815700_ivag019-B16","doi-asserted-by":"publisher","first-page":"ezae018","DOI":"10.1093\/ejcts\/ezae018","article-title":"Comparison of lactated Ringer\u2019s solution and Plasma\u2013Lyte a as a base solution for del Nido cardioplegia: a prospective randomized trial","volume":"65","author":"Kantathut","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026012304315815700_ivag019-B17","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1177\/02184923211048332","article-title":"Modified del Nido versus blood cardioplegia in congenital cardiac surgery","volume":"30","author":"Sithiamnuai","year":"2022","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"2026012304315815700_ivag019-B18","doi-asserted-by":"publisher","first-page":"54","DOI":"10.26779\/2786-832X.2024.4.54","article-title":"A prospective comparative study to assess the effect of modified del Nido versus standard del Nido on myocardial protection in adults","volume":"91","author":"Kumar","year":"2024","journal-title":"UJCS"},{"key":"2026012304315815700_ivag019-B19","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1051\/ject\/2024010","article-title":"Traditional vs. modified Ringer lactate-based del Nido cardioplegia impacts on clinical outcomes in patients undergoing coronary artery bypass grafting: results from a prospective, randomized, blinded trial","volume":"56","author":"Kachoueian","year":"2024","journal-title":"J Extra Corpor Technol"},{"key":"2026012304315815700_ivag019-B20","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1177\/21501351211073610","article-title":"Plasmalyte-A based del Nido cardioplegia versus plain ringer based del Nido cardioplegia: double-blind randomized trial","volume":"13","author":"Talwar","year":"2022","journal-title":"World J Pediatr Congenit Heart Surg"},{"key":"2026012304315815700_ivag019-B21","doi-asserted-by":"publisher","first-page":"E163","DOI":"10.1532\/hsf.4491","article-title":"Is modified del Nido cardioplegia as effective as del Nido cardioplegia in patients with isolated coronary artery bypass surgery?","volume":"25","author":"Karaarslan","year":"2022","journal-title":"Heart Surg Forum"},{"key":"2026012304315815700_ivag019-B22","doi-asserted-by":"publisher","first-page":"387","DOI":"10.5606\/tgkdc.dergisi.2024.26359","article-title":"Early postoperative outcomes of modified del Nido cardioplegia in coronary artery bypass surgery in patients with low ejection fraction","volume":"32","author":"Erol","year":"2024","journal-title":"Turk Gogus Kalp Damar Cerrahisi Derg"},{"key":"2026012304315815700_ivag019-B23","doi-asserted-by":"publisher","first-page":"ezae161","DOI":"10.1093\/ejcts\/ezae161","article-title":"Comparison of modified del Nido and Custodiol cardioplegia in minimally invasive mitral valve surgery","volume":"65","author":"Kang","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026012304315815700_ivag019-B24","doi-asserted-by":"publisher","first-page":"918","DOI":"10.3390\/medicina57090918","article-title":"Efficacy of whole-blood del Nido cardioplegia compared with diluted del Nido cardioplegia in coronary artery bypass grafting: a retrospective monocentric analysis of Pakistan","volume":"57","author":"Haider","year":"2021","journal-title":"Medicina (Kaunas)"},{"key":"2026012304315815700_ivag019-B25","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1186\/s13019-023-02466-0","article-title":"Outcomes of coronary artery bypass surgery using modified del Nido cardioplegia in patients with poor ventricular function","volume":"18","author":"Brown","year":"2023","journal-title":"J Cardiothorac Surg"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivag019\/66400203\/ivag019.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/1\/ivag019\/66400203\/ivag019.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/1\/ivag019\/66400203\/ivag019.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T09:32:08Z","timestamp":1769160728000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivag019\/8424912"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,6]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivag019","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2026,1]]},"article-number":"ivag019"}}