Background

The aim of this study is to compare the clinical results of intermittent antegrade and intermittent antegrade/continuous retrograde cardioplegia techniques in patients undergoing cardiac surgery.

Methods

Between 2023 and 2025, 915 patients (648 males; 59±11.3 years) who underwent cardiac surgery were evaluated. The patients were divided into two groups. Group A (n=415): Those given intermittent antegrade cardioplegia, and Group B (n=500): Those given intermittent antegrade and continuous retrograde cardioplegia. Subgroups were obtained by propensity matching. Group 1 (n=284): Those given intermittent antegrade cardioplegia, and Group 2 (n=284): Those given intermittent antegrade and continuous retrograde cardioplegia.

Results

Baseline demographics, comorbidities, the European system for cardiac operative risk evaluation II, preoperative echocardiographic findings, operative data, cross-clamp times, cardiopulmonary bypass times, and the number of bypassed grafts were similar between Groups 1 and 2. Postoperative ejection fraction was similar between the groups. Postoperative tricuspid annular plane systolic excursion was higher in Group 1 than in Group 2 (median 17-15 mm, respectively, p=0.005). Vasoactive inotrope score was lower in Group 1 than in Group 2. There were no differences between the groups in terms of postoperative day 1 arterial blood gas findings, postoperative blood product use, and postoperative bleeding volume. The laboratory parameters were also similar between the groups on postoperative day 1. There was no statistically significant difference between the two groups in terms of postoperative outcomes. Postoperative exploration, continuous renal replacement therapy, tracheostomy, and mortality were higher in Group 1 compared to Group 2. Conversely, intubation time was longer in Group 2 compared to Group 1. However, no statistically significant difference was observed.

Conclusion

This propensity-matched study supports that intermittent anterograde cardioplegia alone can yield similar postoperative outcomes compared to the combined strategy.