Background: Effective myocardial protection during prolonged aortic cross-clamping remains a key determinant of surgical outcomes in valve and combined cardiac operations. While Custodiol solution enables single-dose administration, it may be associated with myocardial edema and increased inotropic demand. Warm blood cardioplegia combining potassium, magnesium, and lidocaine provides a more physiologic myocardial environment. 

Objective: To assess the efficacy and safety of modified warm blood cardioplegia (WBCP) compared with Custodiol in patients undergoing cardiac surgery with extended aortic cross-clamping. 

Methods: A retrospective analysis was performed on 176 adult patients who underwent mitral or aortic valve replacement or combined procedures. Eighty-six patients received WBCP, while ninety patients received Custodiol. The WBCP protocol included oxygenator priming with sodium bicarbonate, mannitol, and a balanced crystalloid solution, followed by oxygenated blood infusion with a potassium-magnesium- idocaine bolus. Troponin I, CK MB, transesophageal echocardiography (TEE) data, inotropic support, VA-ECMO use, and hospital mortality were analyzed.

Results: Patients in the WBCP group demonstrated significantly lower troponin I (10.5 ± 3.2 vs. 17.4 ± 4.1 ng/mL, p= 0.01) and CK-MB (48.2 ± 14.5 vs. 65.7 ± 18.3 U/L, p = 0.02) levels at ICU admission. Myocardial edema was observed less frequently (14.0% vs. 31.1%, p = 0.01), and the need for inotropic support was reduced (27.9% vs. 1.1%, p = 0.002). VA ECMO use and mortality were comparable between groups. 

Conclusion: Modified warm blood cardioplegia with potassium, magnesium, and lidocaine ensures superior myocardial protection compared with Custodiol during prolonged aortic cross-clamping, demonstrating reduced biochemical and echocardiographic markers of myocardial injury without compromising safety. This approach may represent a safe, effective, and physiologically favorable alternative for adult cardiac surgery. 

Nikita Chibisov is an anesthesiologist, perfusion and intensive care specialist at Botkin Hospital, Moscow, Russia. His clinical work focuses on perioperative management in cardiac surgery, myocardial protection strategies, and extracorporeal circulation. Mr.Chibisov has participated in several research projects evaluating extracorporeal hemoadsorption, advanced myocardial protection techniques, and perfusion optimization during complex valve and coronary operations. He collaborates with multidisciplinary teams integrating anesthesiology, perfusion, and cardiac surgery to enhance patient outcomes. His current research interests include the clinical application of modified warm blood cardioplegia and the development of selective hemoadsorption methods for removing P2Y12 inhibitors in urgent cardiac surgery.