Enhanced myocardial protection in failing hearts: comparative outcomes of single-dose Del Nido and conventional blood cardioplegia in emergency low-ejection fraction coronary artery bypass grafting (CABG)

<p><strong> </strong></p> <p>Abstract</p> <p><strong> </strong></p> <p>Background: Optimal myocardial protection remains challenging in emergency coronary revascularization, especially in patients with severely reduced left ventricular function. Contemporary cardioplegia strategies aim to limit ischemia–reperfusion injury and enhance postoperative ventricular recovery. The aim of this study was to compare operative parameters, early postoperative outcomes, and myocardial functional recovery between single-dose Del Nido cardioplegia and conventional blood cardioplegia in adults with left ventricular ejection fraction (LVEF) ≤40% undergoing emergency isolated coronary artery bypass grafting (CABG).</p> <p>Methods: This retrospective study included 150 consecutive patients with left ventricular ejection fraction (LVEF) ≤40% who underwent emergency isolated CABG between 2022 and 2024. Patients were assigned to either the Del Nido group (n=80) or the conventional blood cardioplegia group (n=70). Demographics, operative variables, postoperative complications, ventricular function changes, and short-term mortality were analyzed. Myocardial recovery was assessed using ΔEF (postoperative minus preoperative LVEF).  .</p> <p>Results: The Del Nido group demonstrated significantly shorter aortic cross-clamp and cardiopulmonary bypass times and required less intraoperative defibrillation. The incidence of postoperative atrial fibrillation was lower in the Del Nido group (18%) compared with conventional blood cardioplegia (29%). Improvement in ventricular function was greater with Del Nido (ΔEF +5.8±2.1%) than with blood cardioplegia (+3.2±2.4%). Rates of stroke, perioperative myocardial infarction, and early mortality were comparable between groups.</p> <p>Conclusion: Single-dose Del Nido cardioplegia provides effective and safe myocardial protection in emergency low-EF CABG, offering improved operative efficiency and superior early ventricular recovery without increasing perioperative complications.</p> <p><strong> </strong></p>