OBJECTIVE

To compare the efficacy and safety of del Nido and Buckberg cardioplegia in patients with coronary artery disease and heart failure (HF) undergoing coronary artery bypass grafting (CABG).

MATERIAL AND METHODS

A prospective randomized study included 154 patients divided into three groups: heart failure with preserved ejection fraction (HFpEF), reduced ejection fraction (HFrEF) and no signs of HF. Within each group, patients were randomized to receive either del Nido or Buckberg cardioplegia. Intraoperative parameters, incidence of rhythm disturbances, biochemical markers of myocardial injury and early postoperative outcomes were assessed.

RESULTS

Del Nido cardioplegia resulted in significantly shorter cardiopulmonary bypass time in patients with HFpEF (81.8±13.4  vs. 92.7±15.1 min with Buckberg; p=0.014) and in patients without HF (78.2±14.6 min  vs. 97.1±18.2 min; p=0.004). In the HFpEF group, del Nido cardioplegia was associated with lower incidence of ventricular fibrillation after reperfusion (8.8% vs. 28.6%; p=0.043) and no need for postoperative pacing (0% vs. 10.7%; p=0.049). Sixteen hours postoperatively, CK-MB levels were lower in the del Nido group across all clinical subgroups including patients with HFpEF (25.3±13.7 U/L vs. 30.0±13.0 U/L; p=0.048). Among patients without HF, postoperative lactate was also lower after del Nido cardioplegia (2.41±1.03 mmol/L vs. 3.83±2.59 mmol/L; p=0.045).

CONCLUSION

Del Nido cardioplegia demonstrated superior clinical outcomes compared to Buckberg cardioplegia, particularly in patients with HFpEF. Del Nido cardioplegia is effective and safe myocardial protection strategy in CABG procedures for patients with high perioperative risk.