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Heart; Surgery, Heart, Functional Disturbance as ResultPhase 4NCT04094168

Clinical Impact of Del Nido Cardioplegia in Adult Cardiac Surgery

A Phase 4 study testing DEL NIDO CARDIOPLEGIA and COLD BLOOD BASED CARDIOPLEGIA in people with Heart; Surgery, Heart, Functional Disturbance as Result, run by JESSICA GARCIA SUAREZ at 1 site in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Cardioplegia solutions have been used for myocardial protection in cardiac surgery for decades. Different cardioplegic strategies have been evaluated. Del Nido cardioplegia was initially used in pediatric patients and has been expanding into adult cardiac centers over the last decade. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
DEL NIDO CARDIOPLEGIA and COLD BLOOD BASED CARDIOPLEGIA
Could I receive a placebo?
No, everyone receives an active treatment
How many people
474 participants
Where
1 siteSpain
Study dates
15 Jun 2018to 28 Feb 2020
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients age 18 years or older undergoing adult cardiac surgery.
  • Elective surgical procedures requiring cardiopulmonary bypass and myocardial arrest.

Who cannot join

  • Emergency surgery.
  • Patients on preoperative inotropic support and/or mechanical circulatory support.
  • Patient who refuse to participate in the study.
  • Lidocaine allergy.
  • Port access mitral valve surgery.

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Puerta de Hierro Hospital

    Majadahonda, Madrid, 28222

Other trials in Spain

About this study

Official title: Clinical Outcomes of Del Nido Cardioplegia in Adult Cardiac Surgery: a Randomized Controlled Trial

Cardioplegia solutions have been used for myocardial protection in cardiac surgery for decades. Different cardioplegic strategies have been evaluated.

Del Nido cardioplegia was initially used in pediatric patients and has been expanding into adult cardiac centers over the last decade. It can be used as a single dose and it is a reasonable tool do decrease cardioplegic interventions. Recent meta-analysis based on 9 retrospective studies has shown that "clinical outcomes of Del Nido cardioplegia are noninferior to the outcomes of conventional cardioplegia in adult cardiac surgery".

To assess the potencial benefits of Del Nido cardioplegia we performed this clinical trial to evaluate superiority of Del Nido cardioplegia compared to cold blood cardioplegia in terms of myocardial protection and clinical-related outcomes. 474 participants will be randomized either into Del Nido cardioplegia protocol or into the cold blood cardioplegia protocol. Perioperative outcomes will be presented.

Read the detailed description

This clinical trial is performed at Puerta de Hierro Hospital in Spain. The protocol has been approved by institutional ethical committee and Spanish Agency of medicines and medical devices (AEMPS).

The aim of the study is to evaluate superiority of Del Nido cardioplegia solution compared to cold blood cardioplegia solution in terms of myocardial protection and clinical-related outcomes.

According to results in recent meta-analysis, the author estimated a total sample size of 474 participants to give 80 % of power at the 5% significant level.

Participants aged 18 years or older undergoing elective cardiac surgery are randomized 1:1 to receive Del Nido cardioplegia solution (study group) and cold blood cardioplegia solution (control group).

Primary outcome will be assessed by biochemical variables of myocardial injury (troponin T level at inmediate post-op, 3-12 hours, 12-24 hours, 24-48 hours post-op); and clinical variables: "Presence of acute myocardial infarction within 72 hours after surgery", "Prolonged low cardiac output", "Prolonged postoperative vasoplegia" within 48 hours after surgery and/or "Ventricular tachyarrythmias" within 24 hours after surgery.

Secondary outcomes include intraoperative variables of myocardial protection (incidence of ventricular fibrillation, inotropic and vasopressor support at the end of surgical intervention, cardiopulmonary bypass time, aortic cross-clamp time) and postoperative clinical outcomes variables (mechanical ventilation time, incidence of delirium, stroke, acute renal failure, atrial fibrillation, length of stay in intensive care unit, length of stay in hospital and In-hospital mortality).

Being tested
DEL NIDO CARDIOPLEGIA, COLD BLOOD BASED CARDIOPLEGIA
Keywords
Del Nido Cardioplegia, Cardioplegia, Adult Cardiac Surgery, Myocardial protection, Heart surgery

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • DEL NIDO CARDIOPLEGIADrug

    Del Nido components: Plasmalyte 148 (1000 ml), NaHCO3 8.4% 1M (13 ml), MgSO4 0,5 M (16,5 ml), Mannitol 20% (16,3 ml), KCl 2 M (13 ml), Lidocaine 2% (6,5 ml).

    Electrolytic composition (l000 ml): Na+ 153 mEq, K+ 31 mEq, Cl - 124 mEq, Mg2+ 19,5 mEq, NaHCO3 13 mEq, Acetate 27 mEq, Sulfate 16,5 mEq, Gluconate 23 mEq.

  • COLD BLOOD BASED CARDIOPLEGIADrug

    Also called CARDIBRAUN

    Cardibraun components: Electrolytic composition (1000 ml): Na+ 185,8 mmol, K+ 24,1 mmol, Cl- 192,8 mmol, Acetate 23 mmol, Fosfate 0,97 mmol, Citrate 6,32 mmol.

Study groups in NCT04094168
Study groupRoleWhat they receive
Del Nido Cardioplegia solutionExperimental1 liter of Del Nido cardioplegia after aortic cross-clamp will be given. Additional dose will be applied if aortic cross-clamp exceeds 90 minutes or whenever cardiac activity is observed.
Receives: Drug: DEL NIDO CARDIOPLEGIA
Cold blood Cardioplegia solutionActive comparatorAdministering of cardioplegia using current standard of care blood-based cardioplegia protocol. An induction dose of whole blood cardioplegia will be given at a temperature of 4-8 degrees, with subsequent doses of cardioplegia every 20 minutes or whenever cardiac activity is observed.
Receives: Drug: COLD BLOOD BASED CARDIOPLEGIA

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Blood troponin levels.

    Biochemical variables of myocardial injury: Blood troponin levels measured at admission in intensive care unit, 12, 24, 48 hours post-op.

    Measured: Up to 48 hours

  2. Acute cardiovascular event.

    Composite outcome of clinical events "Prolonged low cardiac output", "Prolonged postoperative vasoplegia", "Ventricular tachyarrythmias" and/or "Acute myocardial infarction".

    • Prolonged low cardiac output. Inotropic pharmacologic support more than 48 hours in intensive care unit and/or mechanical circulatory support.
    • Prolonged postoperative vasoplegia. Vasopressor support more than 48 hours in intensive care unit.
    • Ventricular tachyarrythmias. Ventricular fibrillation and hemodynamically unstable ventricular tachycardia within 24 hours after surgery.
    • Acute myocardial infarction within 72 hours after surgery.

    Measured: Up to 72 hours

Secondary outcomes (21)
  1. Ventricular fibrillation after aortic cross-clamp removal.

    Incidence of ventricular fibrillation after aortic cross-clamp removal (Y/N).

    Measured: Intraoperative.

  2. Defibrillation requirement.

    Defibrillation requirement after aortic cross-clamp removal (Y/N).

    Measured: Intraoperative.

  3. Cardioplegia delivery.

    Cardioplegia delivery (antegrade, retrograde, both).

    Measured: Intraoperative.

  4. Cardiopulmonary bypass time (CBP).

    Duration of cardiopulmonary bypass (CBP) (min).

    Measured: Intraoperative.

  5. Aortic cross-clamp time

    Duration of aortic cross-clamp time (min).

    Measured: Intraoperative.

  6. Return to cardiopulmonary bypass.

    Failure to separate from cardiopulmonary bypass (Y/N).

    Measured: Intraoperative

  7. Intraoperative packed red blood cells transfusion.

    Intraoperative packed red blood cells transfusion (U).

    Measured: Intraoperative

  8. Intraoperative maximal blood glucose concentration.

    Intraoperative maximal blood glucose concentration (mg/dl).

    Measured: Intraoperative

  9. Postoperative atrial fibrillation.

    New-onset atrial fibrillation or hemodynamically unstable atrial fibrillation that requires treatment (Y/N).

    Measured: Up to 2 weeks.

  10. Reoperation.

    Reoperation within 24 hours after surgery (Y/N).

    Measured: Up to 24 hours.

  11. Inotropic or vasopressor support in intensive care unit.

    Inotropic or vasopressor support in intensive care unit (Y/N).

    Measured: At admission in intensive care unit, 24, 48 hours.

  12. Duration of inotropic support after cardiopulmonary bypass.

    Duration of inotropic support after cardiopulmonary bypass (hours).

    Measured: Up to 2 weeks.

  13. Time to extubation.

    Mechanical ventilation time (min).

    Measured: Up to 2 weeks.

  14. Acute renal failure.

    Incidence of renal failure (Requirement for postoperative renal replacement therapy) (Y/N).

    Measured: Up to 2 weeks.

  15. Ischemic stroke.

    Incidence of ischemic stroke (Y/N).

    Measured: Up to 2 weeks.

  16. Delirium.

    Incidence of delirium (Y/N).

    Measured: Up to 2 weeks.

  17. Postoperative packed red blood cells transfusion.

    Postoperative packed red blood cells transfusion (U)

    Measured: Up to 1 week.

  18. Length of stay in intensive care unit

    Length of stay in intensive care unit (days).

    Measured: through study completion, an average 1 month.

  19. Length of stay in hospital

    Length of stay in hospital (days).

    Measured: through study completion, an average 6 months.

  20. Postoperative ventricular ejection fraction change.

    Postoperative ventricular ejection fraction (LVEF) change (Y/N).

    Measured: through study completion, an average 6 months.

  21. Mortality.

    Mortality (Y/N).

    Measured: through study completion, an average 6 months.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Sep 2019
  2. Study start15 Jun 2018
  3. Primary completion15 Dec 2019
  4. Study completion28 Feb 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
474 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04094168
Sponsor's protocol ID
EUDRA CT 2017-005144-14
Status last verified
Jul 2025
First submitted
13 Sep 2019
Last updated
22 Jul 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: All IPD that underlie results in a publication.

Publications

  • Buckberg GD, Athanasuleas CL. Cardioplegia: solutions or strategies? Eur J Cardiothorac Surg. 2016 Nov;50(5):787-791. doi: 10.1093/ejcts/ezw228. Epub 2016 Jul 1. No abstract available.

    PubMed 27369117
  • Ad N, Holmes SD, Massimiano PS, Rongione AJ, Fornaresio LM, Fitzgerald D. The use of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial. J Thorac Cardiovasc Surg. 2018 Mar;155(3):1011-1018. doi: 10.1016/j.jtcvs.2017.09.146. Epub 2017 Nov 13.

    PubMed 29246552
  • Li Y, Lin H, Zhao Y, Li Z, Liu D, Wu X, Ji B, Gao B. Del Nido Cardioplegia for Myocardial Protection in Adult Cardiac Surgery: A Systematic Review and Meta-Analysis. ASAIO J. 2018 May/Jun;64(3):360-367. doi: 10.1097/MAT.0000000000000652.

    PubMed 28863040
  • Lazar HL. del Nido cardioplegia: Passing fad or here to stay? J Thorac Cardiovasc Surg. 2018 Mar;155(3):1009-1010. doi: 10.1016/j.jtcvs.2017.09.126. Epub 2017 Oct 10. No abstract available.

    PubMed 29110949
  • Tam DY, Fremes SE. Del Nido cardioplegia: A one stop shot for adult cardiac surgery? J Thorac Cardiovasc Surg. 2018 Mar;155(3):1019-1020. doi: 10.1016/j.jtcvs.2017.10.066. Epub 2017 Oct 31. No abstract available.

    PubMed 29198802
  • Garcia-Suarez J, Garcia-Fernandez J, Martinez Lopez D, Reques L, Sanz S, Carballo D, Martin CE, Ospina VM, Villar S, Martin A, Casado M, Villafranca A, Gonzalez AI, Serrano S, Forteza A. Clinical impact of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial. J Thorac Cardiovasc Surg. 2023 Nov;166(5):1458-1467. doi: 10.1016/j.jtcvs.2022.01.044. Epub 2022 Feb 8.

    PubMed 35279289
  • Garcia-Suarez J, Garcia Fernandez J, Sanz S, Martinez Lopez D, Reques L, Forteza Gil A. Del Nido Cardioplegia Versus Cold Blood Cardioplegia in Adult Cardiac Surgery: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2020 Jul 14;9(7):e17826. doi: 10.2196/17826.

    PubMed 32673265

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing DEL NIDO CARDIOPLEGIA and COLD BLOOD BASED CARDIOPLEGIA in people with Heart; Surgery, Heart, Functional Disturbance as Result, run by JESSICA GARCIA SUAREZ at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 22 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Blood troponin levels. (time frame: Up to 48 hours). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04094168, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jul 2025.

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