Background/Aim. Custodiol is a hyperpolarizing cardioplegic solution which has been used in our national cardiac surgical practice exclusively for the heart transplant surgery. Owing to its numerous advantages over the standard depolarizing solutions, Custodiol became cardioplegia of choice for all other cardiac surgical procedures in many cardiosurgical centers. This study evaluates myocardial protection of Custodiol compared to modified St. Thomas cardioplegia in coronary artery bypass surgery. Methods. In a prospective four-month study 110 consecutive adult patients who underwent primary isolated elective on-pump coronary artery bypass grafting (CABG) were randomized into Custodiol group (n=54) and modified St.Thomas group (n=50), based on the type of administered cardioplegia; six patients were excluded. Cardiac protection was achieved as antegrade cold crystalloid cardioplegia by one of the solutions. Myocardial preservation was assessed through following outcomes: spontaneous rhythm restoration post crossclamp, and postpoperative cardiac specific enzymes level, ejection fraction (EF) change, inotropic support, myocardial infarction (MI), atrial fibrillation (AF), and death. Results. Preoperative and intraoperative characteristics were similar except for a considerably longer cross-clamp time in the Custodiol group (49.1±19.0 vs. 41.0±12.9 minutes; p=0.022). Custodiol group exhibited a higher rate of return to spontaneous rhythm (31.5% vs. 20.0%; p=0.267), lower rates of AF (20.4% vs. 28%; p=0.496), MI (1.8% vs. 10.0%; p=0.075) and inotropic support (9.0% vs. 12.0%; p=0.651), albeit not statistically significant. There was an insignificant difference in peak value of Troponin I (5.0±3.92µg/L vs. 4.5±3.39µg/L; p=0.755) and Creatine Kinase-MB (26.9±15,4µg/L vs. 28.5±24.2µg/L; p=0,646) 6 hours post-surgery. EF reduction was comparable (0,81% vs. 1.26%; p=0.891). There were no deaths. Conclusions. Custodiol and modified St.Thomas cardioplegia have comparable cardioprotective effects in CABG surgery. The trends of less frequent MI, AF and inotropic support, despite the longer cross-clamp time in the Custodiol group may suggest that its benefits could be ascertained in a larger study. ApstraktUvod/Cilj. Custodiol je hiperpolari iraju i kardiolegi ni rastvor koji je kori en, u na oj nacionalnoj kardiohirur koj praksi, isklju ivo u transplantacionoj hirurgiji. Zbog svojih brojnih prednosti u odnosu na standarde, depolari iraju e rastvore, Custodiol je, u mnogim kardiohirur kim centrima, postao kardioplegija i bora a sve kardiohirur ke procedure. Cilj studije je procena miokardne protekcije rastvorom Custodiol-a u poređenju sa modifikovanom St. Thomas kardioplegijom u koronarnoj hirurgiji. Metode. Tokom prospektivne etveromese ne studijie, 110 u astopnih odraslih pacijenata podvrgnutih primarnoj, izolovanoj, elektivnoj operaciji aortokoronarnog bajpas su randomizirani na osnovu primenjene kardioplegije u Custodiol grupu (n=54) i modifikovanu St.Thomas

Introduction Anomalous aortic origin of the right and the circumflex coronary arteries presents extremely rare and potentially dangerous combination in patients scheduled for combined coronary bypass grafting and aortic valve replacement surgery. We report this illustrative case to emphasize the importance of meticulous diagnostic setup enabling the surgeon to anticipate and avoid numerous possible pitfalls. Case outline A 74-year-old woman, with anterior-wall myocardial infarction and aortic valve stenosis, underwent successful combined coronary artery bypass grafting and aortic valve replacement. Preoperative coronary angiography revealed unusually high takeoff of the right main coronary trunk and anomalous origin and course of the circumflex coronary artery. Anatomy of both anomalous coronary arteries in the light of underlying surgical pathology necessitated a meticulous preparation and caution during successive phases of surgical treatment. Conclusion Estimating potential procedural risk should be standard practice for each patient with known congenital coronary artery anomalies, regardless of the natural risk imposed by a particular anomaly. Preoperative evaluation of coronary circulation, with high surgical awareness and knowledge of different congenital coronary artery anomalies, should be a standard approach in cardiac surgical practice. This would add a predictive value for an actual procedural risk in cases of previously unrecognized anomalies.

Satisfactory perfusion of organs during the AA surgery is obtained by using both HH and an isotonic solution. Due to maintaining the optimal values of the minute heart volume, saturation of vein blood blended with oxygen, and al-veolo-arterial difference in oxygen, it is recommended to use HH solution for reanimation of patients in declamping shock.

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