A patient with known cold agglutinins requiring an aortic valve replacement was referred for surgery. Asanguinous, Del Nido cardioplegia was used for myocardial protection. Warm induction followed by cold infusion prevented any agglutination and eliminated the need for subsequent cardioplegia doses. Following the cross-clamp period, the heart returned to normal sinus rhythm without need for defibrillation. Postoperative ejection fraction and systolic function were normal.
Keywords: CPB; CPB complications; CPB pathophysiology; Del Nido; aortic valve replacement; cardioplegia; cardiopulmonary bypass; cold agglutinins; inflammatory response; myocardial protection.