title: Custodiol for myocardial protection and preservation: a systematic review.
abstract: BACKGROUND
  Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant.
  
  
  METHODS
  Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant.
  
  
  RESULTS
  Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant.
  
  
  CONCLUSIONS
  Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required.
authors.affiliation: Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia; ; The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia;
authors.forename: J James B
authors.initials: JJ
authors.lastname: Edelman
authors.affiliation: The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia;
authors.forename: Michael
authors.initials: M
authors.lastname: Seco
authors.affiliation: Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Australia;
authors.forename: Ben
authors.initials: B
authors.lastname: Dunne
authors.affiliation: Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Australia;
authors.forename: Shannon J
authors.initials: SJ
authors.lastname: Matzelle
authors.affiliation: Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Australia;
authors.forename: Michelle
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia;
authors.forename: Pragnesh
authors.initials: P
authors.lastname: Joshi
authors.affiliation: The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia;
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.affiliation: The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; ; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia;
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.affiliation: The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia;
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.affiliation: The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; ; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia;
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
authors.affiliation: Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia; ; Notre Dame Medical School, Fremantle, Australia.
authors.forename: Jurgen
authors.initials: J
authors.lastname: Passage
keywords: Custodiol solution; cardiac transplantation; heart arrest; histidine-tryptophan-ketoglutarate solution; induced