Evolution of myocardial protection strategies: The rise of del Nido cardioplegia in adult cardiac surgery

Abstract

Objective

Myocardial protection research in adult cardiac surgery has increasingly examined single dose del Nido cardioplegia alongside conventional multidose blood cardioplegia. Using a scientometric modeling approach, this study aims to quantitatively evaluate whether the thematic emphasis of this literature has expanded over time from pure protection efficacy toward workflow-related procedural parameters.

Methods

A total of 269 focal publications published between 2000 and 2025, representing a 25-years analytical period, comparing myocardial protection strategies were analyzed using the Web of Science (WoS) Core Collection database. Author keywords were stratified by two independent reviewers into two predefined conceptual domains: the Efficacy Domain, including terms related to physiological myocardial protection (e.g., troponin, ischemia-reperfusion), and the Efficiency Domain, including workflow-related procedural parameters (e.g., cross-clamp time, minimally invasive surgery, single dose cardioplegia), with strong inter-rater agreement (Cohen’s κ = 0.92). Temporal trends were quantified using weighted linear regression models to evaluate the association between publication year and the relative prominence of efficiency-domain terminology.

Results

Analysis of publication volume reveals a marked increase in literature, particularly from 2018 onwards. Keyword network analysis identified three distinct clusters: (1) traditional blood cardioplegia, (2) modern adult surgery/minimally invasive applications, and (3) evidence synthesis. Trend analysis demonstrated a statistically significant increase in the prominence of efficiency-related terms over the study period (β = 0.027 per year, 95% CI 0.014–0.040; p for trend <0.01).

Conclusion

This scientometric analysis indicates an increasing emphasis in the literature on workflow-related procedural parameters in the evaluation of cardioplegia strategies in adult cardiac surgery. Contemporary studies increasingly report workflow-related procedural parameters such as uninterrupted surgical flow, cross-clamp time, and compatibility with minimally invasive or robotic techniques in the evaluation of cardioplegia strategies. These findings indicate an expanding investigational emphasis within the literature toward workflow-related procedural parameters alongside traditional efficacy and safety-oriented outcomes.