Comparison of Custodiol® and modified St. Thomas cardioplegia for myocardial protection in coronary artery bypass grafting

Abstract

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

Histidine–tryptophan–ketoglutarate solution versus multidose cardioplegia for myocardial protection in cardiac surgeries: a systematic review and meta-analysis

“…This article updates the previous meta-analysis Reynolds et al 2020 (26), with four added RCTs [ 16 , 17 , 23 , 25 ]. Our findings were consistent with the previous ones to a large extent.…”

“…The mixture was delivered through an antegrade route at a pressure of 80–100 mmHg, and was repeated every 30–45 min. Before myocardial perfusion, another warm blood retrograde dose was administered Cvetković et al [ 17 ] Serbia 104 patients (54 for HTK, and 50 for MDC) The study included adult patients undergoing CABG, having at least two angiographic graftable target vessels (> 2.0 mm in diameter, with ≥ 70% stenosis), LVEF ≥ 30%, and normal valves. Patients > 80 years, having MI within a month of the operation, reoperation, medical emergency off-pump CABG, ongoing myocardial ischemia, pericarditis, coronary endarterectomy, LV surgical restoration, left main stenosis > 50%, or serum creatinine > 200 µmol/L were excluded 20 mL/kg of the solution were administered over 6–8 min, at 4–8 °C, through an antegrade route Crystalloid An initial one liter of St.Thomas solution was administered, over 3–5 min, at 4–8 °C, through an antegrade route.…”

“…Among the included studies, Huet et al [ 6 ] and Cvetković et al [ 17 ] have compared HTK with St Thomas cardioplegia and concluded that no difference between both solutions in terms of safety, efficacy, and hemodynamics.…”

Custodiol (Histidine-Tryptophan-Ketoglutarate) Versus Crystalloid (Saint. Thomas) Cardioplegia on Myocardial Protection in Mitral Valve Replacement Surgeries

“…The peak values of all enzymes were 6h after surgery. 11 Similarly, a meta-analysis performed by 16 (who studied the effects of blood cardioplegia versus crystalloid cardioplegia during cardiac surgery of pediatric) reported that cardiac troponin I level postoperatively was not significantly different between two groups with no evidence of improvement in myocardial injury for either groups .Also study comparing three groups ( custodiol group , st.thomas cardioplegia group and blood cardioplegia solution) during pediatric cardiac surgery and evaluate protective effects of three groups on the myocardial of the heart and found that CK-MB and troponin t levels were not statistically significantly different among the three groups with no superiority for HTK 7 .…”