Alternative Base Solutions for del Nido Cardioplegia: Composition, Rationale, and Clinical Evidence

OBJECTIVES: 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. METHODS: A comprehensive literature review was conducted, analyzing experimental, observational, and randomized clinical studies that compared modified del Nido cardioplegia prepared with various alternative crystalloids. RESULTS: Evidence demonstrates that del Nido cardioplegia prepared with alternative crystalloids including normal saline, lactated Ringer's, plain Ringer's, Isolyte S, Ionosteril, and whole blood provides myocardial protection and postoperative outcomes comparable with Plasma-Lyte A when appropriately buffered and supplemented. CONCLUSIONS: Alternative base solutions including normal saline, lactated Ringer's, plain Ringer's, 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.