{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:17:15Z","timestamp":1783343835746,"version":"3.54.6"},"reference-count":25,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Nanjing Key Medical Science and Technology Development Foundation","award":["ZKX 19021"],"award-info":[{"award-number":["ZKX 19021"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>With the advancement of cardiopulmonary bypass technology, several cardioplegia solutions have been introduced, including del Nido cardioplegia (DN) and histidine-tryptophan-ketoglutarate (HTK) solutions. However, the cardioplegia solution with the most effective myocardial protection in patients undergoing cardiac valve surgery remains controversial. Therefore, we aimed to evaluate the efficacy of myocardial protection using DN cardioplegia solution versus HTK solution in patients who underwent adult cardiac valve surgery by measuring left ventricular strain using two-dimensional speckle-tracking echocardiography (2D-STE) combined with monitoring myocardial enzymes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study population consisted of 99 patients who underwent cardiac valve surgery and were transferred to the intensive care unit postoperatively at Nanjing First Hospital between March 2022 and June 2023. The patients were divided into groups based on the type of cardioplegia solution used intraoperatively: the HTK and Del Nido groups. Using conventional transthoracic echocardiography, we measured left ventricular end-diastolic diameter, left ventricular end-systolic diameter, stroke volume, left ventricular ejection fraction, left atrial diameter, and left ventricular outflow tract velocity time integral (VTI). Left ventricular global longitudinal strain (LV-GLS) was measured preoperatively and on postoperative days 1, 3, and 7 using the 2D-STE technique. The left ventricular longitudinal strain values were recorded in the apical long-axis, two-chamber, and four-chamber views (LAX-GLS, A2C-GLS, A4C-GLS). Serum levels of Troponin I (TNI) and heart-type fatty acid-binding protein (H-FABP) were monitored at each time point. Baseline characteristics, surgical details, biochemical indicators, and postoperative vasopressor use data were collected for both groups. Differences in conventional echocardiography, left ventricular strain, and myocardial enzyme markers between the two groups were compared. Perioperative composite adverse events, including malignant arrhythmias, sudden cardiac arrest, respiratory failure, low cardiac output syndrome, delirium, and mortality, were recorded in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Myocardial injury is reflected by changes in cardiac enzyme levels and left ventricular strain measurements in patients undergoing valve surgery procedures. TNI and H-FABP concentrations in the two groups reached their peaks on the first day after surgery, then showed a gradual downtrend throughout the first week. Compared to the HTK group, the concentration of serum H-FABP at T1 was lower in the Del Nido group (28.42 \u00b1 10.69 vs 20.31 \u00b1 11.20 pg\/mL,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.03), but there were no significant differences between the two groups at T0, T3, and T7. The serum cardiac troponin I (TNI) concentrations were comparable between the HTK group and the Del Nido group. Similarly, no significant differences were observed between the two groups for VTI, LV-GLS, LAX-GLS, A4C-GLS, or A2C-GLS. However, LV-GLS values were significantly lower at all postoperative time points compared to preoperative levels in both groups, indicating impaired left ventricular systolic function postoperatively. The longitudinal strain values of LAX and A4C in the HTK group patients returned to preoperative levels on the seventh day postoperatively (\u221211.26 \u00b1 4.61 vs \u221214.51 \u00b1 5.61,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &gt; 0.05; \u221210.41 \u00b1 5.14 vs \u221213.29 \u00b1 5.86,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &gt; 0.05, respectively). Conversely, in the Del Nido group, the longitudinal strain values remained decreased compared to baseline on postoperative day 7.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Left ventricular strain function experiences a decline in the week immediately following cardiac valve surgery. The accelerated recovery of LAX-GLS and A4C-GLS associated with HTK cardioplegia supports its reliability as a myocardial protectant during extended ischemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591261446483","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T19:58:57Z","timestamp":1776715137000},"page":"639-649","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of the myocardial protection efficacy between Del Nido cardioplegia and HTK cardioplegia in adult cardiac valve surgery"],"prefix":"10.1177","volume":"41","author":[{"given":"Yinying","family":"Xue","sequence":"first","affiliation":[{"name":"Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shangyu","family":"Chen","sequence":"additional","affiliation":[{"name":"Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengqiu","family":"Jiang","sequence":"additional","affiliation":[{"name":"Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jilai","family":"Xiao","sequence":"additional","affiliation":[{"name":"Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Shen","sequence":"additional","affiliation":[{"name":"Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Xu","sequence":"additional","affiliation":[{"name":"Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Hong","sequence":"additional","affiliation":[{"name":"Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochun","family":"Song","sequence":"additional","affiliation":[{"name":"Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0886-6274","authenticated-orcid":false,"given":"Cui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.031461"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0267659120942656"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000039453"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-022-01891-x"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.21470\/1678-9741-2022-0447"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-021-01444-z"},{"issue":"4","key":"e_1_3_6_9_2","first-page":"1","article-title":"Ten years of 2D longitudinal strain for early myocardial dysfunction detection: a clinical overview","volume":"2018","author":"Concetta Z","year":"2019","unstructured":"Concetta Z, Luca L, Rodolfo C, et al. Ten years of 2D longitudinal strain for early myocardial dysfunction detection: a clinical overview. BioMed Res Int 2019; 2018(4): 1\u201314.","journal-title":"BioMed Res Int"},{"key":"e_1_3_6_10_2","doi-asserted-by":"crossref","unstructured":"Michael GG James GG Alberta HY et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med; 11(2): 234\u2013238.","DOI":"10.1097\/PCC.0b013e3181b806fc"},{"issue":"2","key":"e_1_3_6_11_2","first-page":"215","article-title":"Myocardial protection: a forgotten modality","volume":"57","author":"Bradley SA","year":"2019","unstructured":"Bradley SA. Myocardial protection: a forgotten modality. Eur J Cardio Thorac Surg 2019; 57(2): 215.","journal-title":"Eur J Cardio Thorac Surg"},{"issue":"1","key":"e_1_3_6_12_2","first-page":"02411","article-title":"Del Nido versus HTK cardioplegia for myocardial protection during adult complex valve surgery: a retrospective study","volume":"21","author":"Lian D","year":"2021","unstructured":"Lian D, Guo-Huang H, Wang E, et al. Del Nido versus HTK cardioplegia for myocardial protection during adult complex valve surgery: a retrospective study. BMC Cardiovasc Disord 2021; 21(1): 02411.","journal-title":"BMC Cardiovasc Disord"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.996744"},{"key":"e_1_3_6_14_2","unstructured":"Hong-Mei X Hai-Tao H Wen-Tao S et al. del Nido cardioplegia better preserves cardiac diastolic function but histidine-tryptophan-ketoglutarate is better for endothelial function. Eur J Cardio Thorac Surg; 61(6): 1368\u20131378."},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2017.02.009"},{"issue":"2","key":"e_1_3_6_16_2","first-page":"024","article-title":"Global longitudinal strain predicts survival and left ventricular function after mitral valve surgery: a meta-analysis","volume":"33","author":"Martin C","year":"2020","unstructured":"Martin C, Ritu T, Carlos A, et al. Global longitudinal strain predicts survival and left ventricular function after mitral valve surgery: a meta-analysis. Semin Thorac Cardiovasc Surg 2020; 33(2). 024.","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002684"},{"key":"e_1_3_6_18_2","unstructured":"Jan S Stephan MP See HE et al. Left ventricular global longitudinal strain in patients with moderate aortic stenosis. J Am Soc Echocardiogr; 35(8): 008."},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2023.03.003"},{"key":"e_1_3_6_20_2","first-page":"267659124124498","article-title":"Influence of cardioplegic solution on incidence of acute kidney injury after coronary artery bypass surgery procedure: del Nido cardioplegia versus Histidine-Tryptophan-Ketoglutarate solution: insight of kidney disease improving global outcomes criteria","volume":"1","author":"Wang L","year":"2024","unstructured":"Wang L, Dai Q, Hu L, et al. Influence of cardioplegic solution on incidence of acute kidney injury after coronary artery bypass surgery procedure: del Nido cardioplegia versus Histidine-Tryptophan-Ketoglutarate solution: insight of kidney disease improving global outcomes criteria. Perfusion 2024; 1\u20139: 2676591241244983. https:\/\/doi.org\/10.1177\/02676591241244983","journal-title":"Perfusion"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/02676591231163270"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2023.02.045"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-76266-4"},{"key":"e_1_3_6_24_2","first-page":"174","article-title":"Comparison between creatine kinase MB, heart-type fatty acid-binding protein, and cardiac troponin T for detecting myocardial ischemic injury after cardiac surgery","volume":"488","author":"Min Seop J","year":"2018","unstructured":"Min Seop J, Jehoon L, Soo-Young K, et al. Comparison between creatine kinase MB, heart-type fatty acid-binding protein, and cardiac troponin T for detecting myocardial ischemic injury after cardiac surgery. Clin Chim Acta 2018; 488: 174\u2013178.","journal-title":"Clin Chim Acta"},{"key":"e_1_3_6_25_2","first-page":"456","article-title":"Cardiac troponin I and creatine kinase-MB release after different cardiac surgeries","volume":"16","author":"Florinda M","year":"2014","unstructured":"Florinda M, Pietro G, Giuseppe S, et al. Cardiac troponin I and creatine kinase-MB release after different cardiac surgeries. J Cardiovasc Med 2014; 16: 456\u2013464.","journal-title":"J Cardiovasc Med"},{"key":"e_1_3_6_26_2","doi-asserted-by":"crossref","unstructured":"Mirela B Harlinde P Marc L et al. Cold histidine-tryptophan-ketoglutarate solution and repeated oxygenated warm blood cardioplegia in neonates with arterial switch operation. Ann Thorac Surg; 95: 1390\u20131396.","DOI":"10.1016\/j.athoracsur.2012.12.025"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261446483","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591261446483","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261446483","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:30:25Z","timestamp":1783341025000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591261446483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/02676591261446483"],"URL":"https:\/\/doi.org\/10.1177\/02676591261446483","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]}}}