Custodiol cardioplegia for myocardial protection in minimally invasive and open valve surgery
Brian Hummel1, Randall Buss1, Paul DiGiorgi1, George Comas1, Lee Lucas2, Nalani Yaeger2, Brittany Hanna2.
1Gulfcoast Cardiothoracic and Vascular Surgeons, Fort Myers, FL, USA, 2Lee Memorial Hospital System, Fort Myers, FL, USA.
OBJECTIVE: Single dose antegrade crystalloid cardioplegia with custodiol-histidine-trypthophan-ketoglutarate (custodiol) has been used for many years. Its safety and efficacy has been established in experimental and clinical studies. It is beneficial in complex valve surgery because it provides, a long period of myocardial protection with a single dose. Thus, valve procedures (minimally invasive or open) can be performed without interruption. The aim of this study is to compare the use of custodiol cardioplegia with repetitive blood cardioplegia on patients undergoing minimally invasive and open valve surgery.
METHODS: A single institution, retrospective review of 196 valve cases was performed. 98 cases were performed with custodiol cardioplegia and 98 cases were performed with repetitive blood cardioplegia (BCP). Each group consisted of both minimally invasive and open cases. Minimally invasive valve cases were done through via right chest thoracotomy or partial sternotomy. Cases included single valve (aortic or mitral), repair or replacement, or multiple valve replacement, with or without concomitant coronary artery bypass grafting. Demographic, clinicopathologic, perioperative, and outcomes data were collected and analyzed.
RESULTS: Demographics and medical comorbidities were similar between the two groups (custodiol vs BCP). Both groups included minimally invasive and open cases. There were fewer concomitant coronary bypasses in the custodial than in the BCP group (14/98 vs 39/98, p<0.001). The operative mortality was 3.1% in the custodial group vs 5.1% in the BCP group (p=0.47). Postoperative IABP use was 6.1% in the custodial group vs 7.1% in the BCP group (p=0.67). Postoperative troponin was similar between the custodiol and BCP groups (12.6 vs 16, p=ns). Operative stroke was 0% in the custodial group vs 4.1% in the BCP group (p=0.03). Operative atrial fibrillation was 47% in the custodial group vs 50% in the BCP group (p=0.21). Postoperative length of stay was similar between the custodiol and BCP groups (7.65 vs 8.82, p=ns). CPB time, operative room time, and costs were reduced by using custodiol cardioplegia.
CONCLUSIONS: Use of single dose, antegrade custodiol-HTK cardioplegia is safe and effective when compared with traditional repetitive blood cardioplegia in patients undergoing minimally invasive and open valve surgery.
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