{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:55:39Z","timestamp":1792176939961,"version":"4.4.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Minimally invasive mitral valve repair (MIMVR) is the preferred approach to treat mitral regurgitation in specialized centres. Custodiol and Del Nido cardioplegia are widely used, yet direct comparative data on their efficacy and safety in this setting remain limited. This study investigated their efficacy and impact on early outcomes in a propensity-matched cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a single-centre, retrospective matched cohort study of 2490 patients undergoing minimally invasive mitral valve surgery between October 2014 and January 2025. After exclusions, 960 patients entered 1:1 propensity score matching based on risk factors, baseline characteristics and procedural parameters, yielding 778 matched cases treated with Custodiol or Del Nido cardioplegia. Perioperative dynamics of cardiac enzymes were evaluated as the primary outcome measure, along with an exploratory analysis on clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Del\u202fNido cardioplegia was associated with lower postoperative creatine kinase and creatine kinase\u2011MB levels, most pronounced in the first 24\u202fhours (P\u202f&amp;lt;\u202f.001). Del\u202fNido yielded a lower inotrope score at 6\u202fhours, higher perioperative sodium and fewer cardioversions for ventricular arrhythmia after declamping with fewer shocks required (all P\u202f&amp;lt;\u202f.001). Rates of major complications were similar between groups, and 30\u2011day mortality was 0% in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Del Nido cardioplegia provided superior myocardial protection based on biomarker dynamics and a lower incidence of post-cross-clamp ventricular arrhythmia, while overall clinical outcomes remained comparable. It may therefore be considered the preferred single-dose cardioplegic solution for MIMVR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivag074","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T12:55:25Z","timestamp":1772283325000},"source":"Crossref","is-referenced-by-count":1,"title":["Custodiol Versus Del Nido Cardioplegia in Minimally Invasive Mitral Valve Repair\u2013a Propensity Score-Matched Study"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6241-6544","authenticated-orcid":false,"given":"Dustin","family":"Greve","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3479-4537","authenticated-orcid":false,"given":"Serdar","family":"Akansel","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Holler","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Dini","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilija","family":"Miskinyte","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9602-2794","authenticated-orcid":false,"given":"Hristian","family":"Hinkov","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research) , 10785 Berlin,","place":["Germany"]},{"name":"Structural Heart Interventions Program (SHIP), Deutsches Herzzentrum der Charit\u00e9 (DHZC) , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7911-8620","authenticated-orcid":false,"given":"Volkmar","family":"Falk","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research) , 10785 Berlin,","place":["Germany"]},{"name":"Department of Health Science and Technology, Swiss Federal Institute of Technology , 8092 Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2009-6375","authenticated-orcid":false,"given":"J\u00f6rg","family":"Kempfert","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6932-7157","authenticated-orcid":false,"given":"Markus","family":"Kofler","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"2026031814263157500_ivag074-B1","doi-asserted-by":"publisher","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"46","author":"Praz","year":"2025","journal-title":"Eur Heart J"},{"key":"2026031814263157500_ivag074-B2","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1093\/ejcts\/ezab568","article-title":"Minimally invasive endoscopic mitral valve repair-the new gold standard for degenerative mitral valve disease","volume":"61","author":"Kempfert","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026031814263157500_ivag074-B3","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1080\/17434440.2021.1894925","article-title":"Mitral valve surgery: current status and future prospects of the minimally invasive approach","volume":"18","author":"Van Praet","year":"2021","journal-title":"Expert Rev Med Devices"},{"key":"2026031814263157500_ivag074-B4","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1177\/02676591231174579","article-title":"A review and meta-analysis of conventional sternotomy versus minimally invasive mitral valve surgery for degenerative mitral valve disease focused on the last decade of evidence","volume":"39","author":"Hussain","year":"2024","journal-title":"Perfusion"},{"key":"2026031814263157500_ivag074-B5","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1186\/s13019-021-01578-9","article-title":"Minimally invasive or sternotomy approach in mitral valve surgery: a propensity-matched comparison","volume":"16","author":"Pojar","year":"2021","journal-title":"J Cardiothorac Surg"},{"key":"2026031814263157500_ivag074-B6","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.asjsur.2023.09.001","article-title":"Sugisman. Outcomes of minimally invasive versus conventional sternotomy for redo mitral valve surgery according to mitral valve academic research consortium: a systematic review and meta-analysis","volume":"47","author":"Hanafy","year":"2024","journal-title":"Asian J Surg"},{"key":"2026031814263157500_ivag074-B7","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1001\/jama.2023.7800","article-title":"Minithoracotomy vs conventional sternotomy for mitral valve repair: a randomized clinical trial","volume":"329","author":"Akowuah","year":"2023","journal-title":"JAMA"},{"key":"2026031814263157500_ivag074-B8","first-page":"803","article-title":"Myocardial protection during minimally invasive mitral valve surgery: strategies and cardioplegic solutions","volume":"2","author":"Garbade","year":"2013","journal-title":"Ann Cardiothorac Surg"},{"key":"2026031814263157500_ivag074-B9","first-page":"717","article-title":"Custodiol for myocardial protection and preservation: a systematic review","volume":"2","author":"Edelman","year":"2013","journal-title":"Ann Cardiothorac Surg"},{"key":"2026031814263157500_ivag074-B10","doi-asserted-by":"crossref","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":"2026031814263157500_ivag074-B11","doi-asserted-by":"crossref","first-page":"e047942","DOI":"10.1136\/bmjopen-2020-047942","article-title":"Comparison between Custodiol, Del Nido and modified Del Nido in the myocardial protection - Cardioplegia trial: a study protocol for a randomised, double-blind clinical trial","volume":"11","author":"Almeida","year":"2021","journal-title":"BMJ Open"},{"key":"2026031814263157500_ivag074-B12","doi-asserted-by":"publisher","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":"2026031814263157500_ivag074-B13","doi-asserted-by":"crossref","first-page":"996744","DOI":"10.3389\/fcvm.2022.996744","article-title":"Comparative effects of different types of cardioplegia in cardiac surgery: a network meta-analysis","volume":"9","author":"Tan","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"2026031814263157500_ivag074-B14","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezad212","article-title":"Image-based ring size prediction for mitral valve repair","volume":"64","author":"Akansel","year":"2023","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026031814263157500_ivag074-B15","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivac200","article-title":"Periareolar endoscopic minimally invasive cardiac surgery: postoperative scar assessment analysis","volume":"35","author":"Van Praet","year":"2022","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2026031814263157500_ivag074-B16","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1510\/mmcts.2022.017","article-title":"Endoaortic balloon occlusion in minimally invasive mitral valve surgery","volume":"2022","author":"Van Praet","year":"2022","journal-title":"Multimed Man Cardiothorac Surg"},{"key":"2026031814263157500_ivag074-B17","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1177\/15569845221083047","article-title":"Endoaortic balloon occlusion during minimally invasive mitral valve surgery","volume":"17","author":"Van Praet","year":"2022","journal-title":"Innovations (Phila)"},{"key":"2026031814263157500_ivag074-B18","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaf258","article-title":"Endo-aortic balloon occlusion versus transthoracic clamping in minimally invasive mitral valve surgery","volume":"67","author":"Kofler","year":"2025","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026031814263157500_ivag074-B19","doi-asserted-by":"crossref","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth universal definition of myocardial infarction (2018)","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"2026031814263157500_ivag074-B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v042.i08","article-title":"MatchIt: nonparametric preprocessing for parametric causal inference","volume":"42","author":"Ho","year":"2011","journal-title":"J Stat Softw"},{"key":"2026031814263157500_ivag074-B21","doi-asserted-by":"crossref","first-page":"e161","DOI":"10.1016\/j.jtcvs.2020.11.163","article-title":"Comparison of Del Nido and histidine-tryptophan-ketoglutarate cardioplegic solutions in minimally invasive cardiac surgery","volume":"164","author":"Lee","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026031814263157500_ivag074-B22","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1177\/02676591231161920","article-title":"Del Nido and histidine-tryptophan-ketoglutarate cardioplegia in minimally invasive mitral valve surgery: a propensity-Match study","volume":"39","author":"Malvindi","year":"2024","journal-title":"Perfusion"},{"key":"2026031814263157500_ivag074-B23","doi-asserted-by":"crossref","first-page":"2248","DOI":"10.3390\/jcm14072248","article-title":"Efficacy of single-dose Del Nido cardioplegia beyond 90 minutes in adult cardiac surgery","volume":"14","author":"Y\u00fccel","year":"2025","journal-title":"J Clin Med"}],"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\/ivag074\/67235016\/ivag074.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/3\/ivag074\/67235016\/ivag074.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/3\/ivag074\/67235016\/ivag074.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T18:26:42Z","timestamp":1773858402000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivag074\/8506514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,12]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivag074","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2026,3]]},"article-number":"ivag074"}}