A Modified Hybrid Cardioplegia Strategy Associated with Reduced Postoperative Bleeding and Re-Exploration Following Bentall Procedures: A Retrospective Single-Center Observational Study

Background: Postoperative bleeding remains an important source of morbidity following Bentall procedures despite numerous technical refinements aimed at improving hemostasis. We evaluated whether a modified hybrid cardioplegia strategy incorporating intermittent blood cardioplegia during aortic root reconstruction could reduce bleeding-related complications compared with a conventional double-dose del Nido strategy. Methods: A total of 103 consecutive patients who underwent Bentall procedures were retrospectively analyzed. Patients were divided according to the myocardial protection strategy employed: conventional double-dose del Nido cardioplegia (Group 1, n = 46) and a modified hybrid strategy consisting of initial del Nido cardioplegia followed by intermittent blood cardioplegia during root reconstruction (Group 2, n = 57). The primary endpoint was postoperative re-exploration for bleeding during the index hospitalization. Additional bleeding-related outcomes included 24 h drainage volume and blood product transfusion requirements. Secondary endpoints were intensive care unit (ICU) stay, hospital stay, and in-hospital mortality. Results: Baseline characteristics, cardiopulmonary bypass times, and aortic cross-clamp durations were comparable between groups. Group 2 demonstrated significantly lower 24 h postoperative drainage volumes compared with Group 1 (450 [350–550] mL vs. 550 [400–650] mL, p = 0.005). Postoperative re-exploration for bleeding occurred significantly less frequently in Group 2 than in Group 1 (3.5% vs. 19.6%, p = 0.011). No significant differences were observed in red blood cell transfusion (p = 0.112), fresh frozen plasma transfusion (p = 0.339), or platelet transfusion requirements (p = 0.147). Mechanical ventilation duration (p = 0.423), intensive care unit stay (p = 0.342), and hospital stay (p = 0.103) were similar between groups. In-hospital mortality did not differ significantly between the groups (4.3% vs. 3.5%, p = 1.000); however, the study was not powered to detect differences in mortality because of the low number of events. Conclusions: In patients undergoing Bentall procedures, a modified hybrid cardioplegia strategy incorporating intermittent blood cardioplegia during aortic root reconstruction was associated with lower postoperative drainage volumes and fewer re-explorations for bleeding compared with a conventional double-dose del Nido strategy. These findings suggest that cardioplegia delivery may contribute to intraoperative hemostatic optimization beyond its traditional role in myocardial protection. Larger prospective studies are warranted to validate these observations.