Introduction: Cardioplegia is responsible to prevent damage to the heart muscle during open heart operation, also to create a sterile, bloodless operating environment. The perfect cardioplegic solution for protection of the myocardium during operations on the heart is still controversial. Aim: To compare the intraoperative and postoperative requirement for an intra-aortic balloon pump between custodiol histidine-tryptophan-ketoglutarate (HTK) cardioplegia versus traditional crystalloid cardioplegia. Methods: A prospective clinical trial investigation, conducted on 48 individuals underwent pump coronary artery bypass graft surgery. done in the routine cardiothoracic surgeries, Suez Canal University Hospital from 2020 to 2023. Results: The mean lactate one minute and 15 minutes after CC removal was statistically significantly larger in Antegrade traditional cold crystalloid cardioplegia (ICCC) group than in HTK group. The mean CK-MB 15 minutes after reperfusion, 6, 12 and 1 day postoperatively was statistically significantly greater in ICCC group than in HTK group. The mean CTnI 15 minutes after reperfusion, and 6 hours postoperatively was statistically significantly more in ICCC group than in HTK group, group A was statistically significantly advanced in heart rate than group B regarding half an hour after weaning (p= 0.001), one hour after weaning (p= 0.001), sternal closure (p= 0.001) and skin closure (p= 0.002).. Conclusion: According to the biomarkers of myocardial injury, a single dose of custodiol HTK is more effective at preserving the myocardium during coronary artery bypass surgery than intermittent ante grade cold crystalloid cardioplegia. This was determined by comparing the two treatments.