The Use of del Nido Cardioplegia in Adults and Pediatric Patients Undergoing Minimally Invasive Endoscopic Cardiac Surgery.

OBJECTIVE: Minimally invasive cardiac surgery (MICS) offers faster recovery and improved patient satisfaction compared with sternotomy, but limited exposure makes myocardial protection challenging. Use of del Nido cardioplegia (DNC), originally developed for pediatrics, is increasing in adults due to its single-dose administration and prolonged arrest. METHODS: Following PRISMA guidelines, PubMed was searched for studies published between September 1, 2015, and September 30, 2025, evaluating DNC in MICS or sternotomy-sparing cardiac surgery. Seven studies met inclusion criteria, including retrospective propensity-matched cohorts, 1 prospective randomized single-center trial, and 1 network meta-analysis. RESULTS: DNC was consistently linked to lower cardioplegia volume, fewer repeat doses, and shorter cross-clamp and bypass times compared with blood or histidine-tryptophan-ketoglutarate (HTK) solutions. Some studies reported reduced postoperative enzyme release, particularly with ischemic times <100 min. Safety outcomes, including mortality, complications, and recovery, were comparable across groups. Meta-analytic evidence suggested procedural efficiency advantages, while Custodiol ranked highest overall. CONCLUSIONS: DNC appears to be a safe alternative in MICS, offering workflow-related procedural efficiency while maintaining comparable myocardial protection. However, current evidence is mostly retrospective and single center. Large, multicenter, randomized trials are needed to establish its role versus HTK and Custodiol in sternotomy-sparing procedures.