{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T12:26:53Z","timestamp":1786796813326,"version":"build-2736575974"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Myocardial protection is crucial in heart surgery to minimize ischemia-reperfusion injury. Del Nido cardioplegia has demonstrated clinical advantages; however, cost-effectiveness data over Custodiol remain scarce. We aimed to assess whether Del Nido could achieve comparable clinical outcomes at lower costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective single-center study was conducted on patients \u226518\u00a0years undergoing isolated surgical aortic valve replacement between 2009\u20132023. Patients received either Custodiol or Del Nido cardioplegia at the discretion of the surgical team. 30-day major adverse cardiac events (MACE) outcomes were extracted from medical records. Cost data was collected from hospital records. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics and mitigate indication bias. Incremental cost-effectiveness ratios (ICERs) were calculated, and probabilistic sensitivity analyses were performed using Monte Carlo simulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>179 patients were included (58 Custodiol, 121 Del Nido). While both alternatives had similar 30-day survival (98.3%) and MACE-free survival (88.4% vs. 89.7%), the cost for Del Nido was lower (41,761 USD vs. 47,599 USD). Using the IPTW-weighted sample, an ICER of 123,363 USD for Custodiol favored Del Nido, particularly under local willingness-to-pay thresholds of 6,947\u201320,841 USD. Probabilistic sensitivity analyses confirmed the robustness of these findings, with Del Nido being cost-effective in up to 75.5% simulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Del Nido cardioplegia offers a cost-effective alternative to Custodiol, providing similar clinical outcomes at lower costs. These findings support the adoption of Del Nido in resource-limited settings, emphasizing value-based care in cardiac surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591261475489","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T10:44:36Z","timestamp":1786531476000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Del Nido cardioplegia is a cost-effective alternative to custodiol for myocardial protection in aortic valve surgery: A real-world study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1649-5290","authenticated-orcid":false,"given":"Kevin","family":"Maldonado-Ca\u00f1\u00f3n","sequence":"first","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"},{"name":"Department of Clinical Epidemiology and Biostatistics, PhD Program in Clinical Epidemiology, Pontificia Universidad Javeriana, Bogot\u00e1, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia Alejandra","family":"Prada Li\u00e9vano","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9ctor","family":"Olaya","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"},{"name":"Cl\u00ednica Universitaria Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2031-730X","authenticated-orcid":false,"given":"Valentina","family":"P\u00e9rez-Ariza","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"},{"name":"Universidad de los Andes"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9329-5618","authenticated-orcid":false,"given":"Andr\u00e9s Felipe","family":"Barrera Vargas","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Andr\u00e9s","family":"Sarmiento","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3141-5420","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Motta","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"},{"name":"Universidad de los Andes"},{"name":"Fundaci\u00f3n Santa Fe de Bogot\u00e1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7937-7676","authenticated-orcid":false,"given":"Carlos","family":"P\u00e9rez Rivera","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"},{"name":"Universidad de los Andes"},{"name":"Fundaci\u00f3n Santa Fe de Bogot\u00e1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00e1s","family":"Forero","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"},{"name":"Universidad de los Andes"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Ni\u00f1o","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"},{"name":"Montefiore Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Maldonado-Escalante","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universitaria Colombia"},{"name":"Cl\u00ednica Universitaria Colombia"},{"name":"Fundaci\u00f3n Santa Fe de Bogot\u00e1"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi007"},{"issue":"3","key":"e_1_3_7_3_2","first-page":"241","article-title":"Myocardial resistance and tolerance to ischemia: physiological and biochemical basis","volume":"16","author":"Bretschneider HJ","year":"1975","unstructured":"Bretschneider HJ, H\u00fcbner G, Knoll D, et al. Myocardial resistance and tolerance to ischemia: physiological and biochemical basis. J Cardiovasc Surg 1975; 16(3): 241\u2013260.","journal-title":"J Cardiovasc Surg"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1051\/ject\/201244098"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.21470\/1678-9741-2022-0447"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-021-02411-w"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/02676591221080653"},{"issue":"2","key":"e_1_3_7_8_2","first-page":"81","article-title":"Del Nido versus Bretschneider cardioplegic solution in valve replacement for severe aortic stenosis - a case-control pilot study","volume":"19","author":"Sanetra K","year":"2022","unstructured":"Sanetra K, Domaradzki W, Bia\u0142ek K, et al. Del Nido versus Bretschneider cardioplegic solution in valve replacement for severe aortic stenosis - a case-control pilot study. 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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; 2676591241244983. https:\/\/doi.org\/10.1177\/02676591241244983","journal-title":"Perfusion"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.09.140"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6607"},{"key":"e_1_3_7_15_2","volume-title":"PPP conversion factor, GDP (LCU per international $) international comparison program, world bank | world development indicators database","author":"World Bank Group","unstructured":"World Bank Group. PPP conversion factor, GDP (LCU per international $) international comparison program, world bank | world development indicators database. 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