Del Nido cardioplegia is a cost-effective alternative to custodiol for myocardial protection in aortic valve surgery: A real-world study
Kevin Maldonado-Cañón, Silvia Alejandra Prada Liévano, Héctor Olaya, Valentina Pérez-Ariza, Andrés Felipe Barrera Vargas, Juan Andrés Sarmiento, Andrés Motta, Carlos Pérez Rivera, Nicolás Forero, Santiago Niño, Javier Maldonado-EscalanteIntroduction
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.
Methods
A retrospective single-center study was conducted on patients ≥18 years undergoing isolated surgical aortic valve replacement between 2009–2023. 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.
Results
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 6,947–20,841 USD. Probabilistic sensitivity analyses confirmed the robustness of these findings, with Del Nido being cost-effective in up to 75.5% simulations.
Conclusions
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.