Custodiol versus blood cardioplegia in complex cardiac operations: an Australian experience.
OBJECTIVE
A single or dual-dose strategy for myocardial protection is attractive in long operations, in avoiding the need to interrupt the procedure to re-administer cardioplegia. We hypothesized that a single administration of Bretschneider histidine-tryptophan-ketoglutarate (HTK) crystalloid solution (Custodiol) offers myocardial protection comparable with repeated tepid blood cardioplegia.


METHODS
We reviewed a prospectively compiled single-centre database containing all adult cardiac procedures performed from January 2005 to January 2011. Preoperative demographic and investigative data, operative variables and postoperative (30-day) mortality and morbidity were compared between the Custodiol and blood cardioplegia groups. The study primary endpoints were 30-day mortality, return to the operating theatre, myocardial infarction, stroke, postoperative requirement for an intra-aortic balloon pump, new renal failure, prolonged ventilation and re-admission to hospital within 30 days. Propensity score matching was performed to correct for any bias that may have been associated with the usage of Custodiol.


RESULTS
A total of 1900 cardiac surgical procedures were identified of which 126 (7%) utilized Custodiol and 1774 (93%) used blood cardioplegia as the primary cardioplegic agent. After propensity-score matching, we were able to match 71 Custodiol cases one-to-one to those receiving blood cardioplegia. There were no statistically significant differences noted for any of the endpoints studied after propensity-score matching. In particular, the proportion of mortality (blood cardioplegia: 1 vs Custodiol 4%, P = 0.63) any mortality/morbidity (blood cardioplegia: 35 vs Custodiol: 39% P = 0.46) was similar between the groups.


CONCLUSIONS
The use of Custodiol is convenient, simple and at least as safe as tepid blood cardioplegia for myocardial protection in complex cardiac operations. A randomized prospective comparison of myocardial protection strategies is warranted.
Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Australia. ff_viana@hotmail.com
Fabiano F
FF
Viana
William Y
WY
Shi
Philip A
PA
Hayward
Marco E
ME
Larobina
Frank
F
Liskaser
George
G
Matalanis
D000368:Aged; D001315:Australia; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000188:drug therapy / Q000517:prevention & control; D019188:Organ Preservation Solutions / Q000627:therapeutic use*; D011189:Potassium Chloride / Q000627:therapeutic use; D011343:Procaine / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
C039984:Bretschneider cardioplegic solution; D002316:Cardiotonic Agents; D019188:Organ Preservation Solutions; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose