{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:02:37Z","timestamp":1785250957355,"version":"3.55.0"},"reference-count":14,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>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\u2013550] mL vs. 550 [400\u2013650] 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.<\/jats:p>","DOI":"10.3390\/jcdd13080353","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:37:00Z","timestamp":1785249420000},"page":"353","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Modified Hybrid Cardioplegia Strategy Associated with Reduced Postoperative Bleeding and Re-Exploration Following Bentall Procedures: A Retrospective Single-Center Observational Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4468-0373","authenticated-orcid":false,"given":"Ahmet S\u00fcha","family":"Arslan","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Adana City Training and Research Hospital, 01230 Adana, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6952-437X","authenticated-orcid":false,"given":"Suat","family":"Karaca","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Adana City Training and Research Hospital, 01230 Adana, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130brahim","family":"\u00d6zs\u00f6yler","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Adana City Training and Research Hospital, 01230 Adana, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1186\/s13019-024-02846-0","article-title":"Del Nido cardioplegia versus cold blood cardioplegia in adult cardiac surgery: A meta-analysis of randomized clinical trials","volume":"19","author":"Li","year":"2024","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1016\/j.jtcvs.2023.09.057","article-title":"Del Nido versus blood cardioplegia in cardiac surgery: A multicenter analysis of over 40,000 patients","volume":"168","author":"Hawkins","year":"2024","journal-title":"J. Thorac. Cardiovasc Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1053\/j.jvca.2025.01.007","article-title":"Effect of del Nido Cardioplegia on Isolated Coronary Artery Bypass Grafting: A Study-level Meta-analysis","volume":"39","author":"Yamashita","year":"2025","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1186\/s13019-024-03006-0","article-title":"Can heartbeat recovery be improved with terminal non-cardioplegic warm blood perfusion prior to aortic unclamping in single-clamp technique coronary artery bypass surgery? A randomized controlled trial","volume":"19","author":"Satdhabudha","year":"2024","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Totaro, P., Musto, M., Tulumello, E., Degani, A., Argano, V., and Pelenghi, S. (2025). Selective Vein Graft Cold Cardioplegia and Warm Reperfusion to Enhance Early Recovery in Patients with Left Ventricle Depression Undergoing Coronary Artery Surgery. J. Cardiovasc Dev. Dis., 12.","DOI":"10.3390\/jcdd12060222"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lamy, A., Browne, A., Whitlock, R.P., Chan, M.T.V., Underwood, M.J., Parlow, J.L., Allard, R.V., Lomivorotov, V.V., Marat, A., and Landoni, G. (2026). Association between complications and mortality after cardiac surgery: Results from the VISION Cardiac Surgery prospective cohort study. J. Thorac. Cardiovasc Surg., Online ahead of print, S0022-5223(26)01052-4.","DOI":"10.1016\/j.jtcvs.2026.04.056"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.1016\/S0003-4975(01)02439-0","article-title":"A new modified Bentall procedure: The flanged technique","volume":"71","author":"Yakut","year":"2001","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4337","DOI":"10.21037\/jtd-23-201","article-title":"Clinical outcomes of the cuff wrapping technique in the modified Bentall procedure: A propensity score-matched study","volume":"15","author":"Huang","year":"2023","journal-title":"J. Thorac. Dis."},{"key":"ref_10","first-page":"206","article-title":"Hemostatic modifications of the Bentall procedure: Imbricated proximal suture and fibrin sealant reduce postoperative morbidity and mortality rates","volume":"39","author":"Baldascino","year":"2012","journal-title":"Tex. Heart Inst. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/0003-4975(93)90146-9","article-title":"New technique for improving hemostasis in aortic root replacement with composite graft","volume":"55","author":"Copeland","year":"1993","journal-title":"Ann. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Akkaya, \u00d6., Jalalzai, I., and Arslan, \u00dc. (2026). Posterior Teflon-Felt-Reinforced Coronary Button Anastomosis in a Modified Bentall Procedure: Early Outcomes in a Single-Center Retrospective Study. J. Clin. Med., 15.","DOI":"10.3390\/jcm15072546"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"6733","DOI":"10.21037\/jtd.2018.11.61","article-title":"Eighteen years of clinical experience with a modification of the Bentall button technique for total root replacement","volume":"10","author":"Karangelis","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5795","DOI":"10.1097\/JS9.0000000000001765","article-title":"Re-exploration for bleeding and long-term survival after adult cardiac surgery: A meta-analysis of reconstructed time-to-event data","volume":"110","author":"Soletti","year":"2024","journal-title":"Int. J. Surg."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/353\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:44:36Z","timestamp":1785249876000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcdd13080353"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13080353","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]}}}