Custodiol cardioplegia solution compared to cold blood cardioplegia in pediatric cardiac surgery: a single-institution experience

Bibevski, Steven; Mendoza, Laura; Ruzmetov, Mark; Tayon, Kevin; Alkon, Jaime; Vandale, Breanna; Scholl, Frank G.

doi:10.1177/0267659119878006

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…A single-dose HTK perfusion regimen is becoming more frequent in technically complex heart surgeries requiring a long AC. The median AC time in this study cohort was above 80 min, which is consistent with previous studies where AC time exceeded 60 min [5,14] . This retrospective study aimed to investigate the clinical influence of high dosage HTK perfusion on neonatal patients.…”

Section: Discussionsupporting

confidence: 88%

“…The median AC time in this study cohort was above 80 min, which is consistent with previous studies where AC time exceeded 60 min. [ 5 , 14 ] This retrospective study aimed to investigate the clinical influence of high dosage HTK perfusion on neonatal patients. The HTK dosage in the high-dose group was significantly higher than in previous studies.…”

Section: Discussionmentioning

confidence: 99%

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Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management

Bai

Tong

Liu

et al. 2021

Chinese Medical Journal

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Background: Histidine-tryptophan-ketoglutarate (HTK) is a solution commonly used for organ transplantation. However, there is no certified fixed regimen for on-pump heart surgery in neonates. We aimed to retrospectively evaluate the outcomes related to different HTK dosages and to analyze the safety of high-dosage perfusion. Methods: A total of 146 neonates who underwent on-pump heart surgery with single-shot HTK perfusion were divided into two groups according to HTK dosages: a standard-dose (SD) group ( n = 63, 40 mL/kg < HTK ≤ 60 mL/kg) and a high-dose (HD) group ( n = 83, HTK >60 mL/kg). Propensity score matching (PSM) was performed to control confounding bias. Results: The SD group had a higher weight (3.7 ± 0.4 vs. 3.4 ± 0.4 kg, P < 0.0001), a lower proportion of complete transposition of the great artery (69.8% vs. 85.5%, P = 0.022), a lower cardiopulmonary bypass (CPB) time (123.5 [108.0, 136.0] vs. 132.5 [114.8, 152.5] min, P = 0.034), and a lower aortic x-clamp time (82.9 ± 27.1 vs. 95.5 ± 26.0 min, P = 0.005). After PSM, 44 patients were assigned to each group; baseline characteristics and CPB parameters between the two groups were comparable. There were no significant differences in peri-CPB blood product consumption after PSM ( P > 0.05). The incidences of post-operative complications were not significantly different between the two groups. There were no significant differences in ventilation time, intensive care unit stay, and post-operative hospital stay ( P > 0.05). Follow-up echocardiography outcomes at 1 month, 3 to 6 months, and 1 year showed that left ventricular ejection fraction and end-diastolic dimension were comparable between the two groups. Conclusions: In neonatal on-pump cardiac surgery patients, single-shot HD (>60 mL/kg) HTK perfusion had a comparable heart protection effect and short-term post-operative prognosis as standard dosage perfusion of 40 to 60 mL/kg. Thus, this study provides supporting evidence of the safety of HD HTK perfusion.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management

Bai

Tong

Liu

et al. 2021

Chinese Medical Journal

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“…As regards inotropic support in this study, maximum VIS was lower in the HHB group, after 24 h and 48 h (p=0.133 and 0.453, respectively). However, there was no statistically significant difference between both groups Bibevski et al (Bibevski et al 2020) proved that there was a significantly lower inotrope score in the custodiol (9.3 ± 2.6) in comparison with the blood group (10.4 + 3), p= 0.03. In their study, scores were calculated for all patients within the first 48 h after surgery, and the highest calculated score was recorded.…”

Section: Discussionmentioning

confidence: 91%

“…Also, Bibevski et al (Bibevski et al 2020) found that there was no difference as regards biventricular function assessed using echocardiography (LVEF, LVFS, RVFAC) between cold blood microplegia (blood with K+ at 30 mEq and magnesium 10 mL/L) and HTK crystalloid solution group.…”

Section: Discussionmentioning

confidence: 99%

Myocardial protection with histidine-tryptophan-ketoglutarate solution in comparison with hypothermic hyperkalemic blood solution in the correction of acyanotic congenital heart diseases

Ali

Elnasr

Kamal

et al. 2022

Ain-Shams J Anesthesiol

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Background Intraoperative myocardial preservation is essential in pediatric cardiac surgeries. The combination of hypothermia and hyperkalemic cardioplegia is commonly used. Histidine-tryptophan-ketoglutarate (HTK–Custodiol) is a long-acting crystalloid cardioplegia which induces cardiac arrest by reducing the extracellular sodium concentration. Cold blood cardioplegia has many modifications differing in the blood: crystalloid ratio, buffers, substrates, and final potassium concentration which induces cardiac arrest in diastole as the main role. We compared cold histidine-tryptophan-ketoglutarate crystalloid (HTK) solution with hypothermic hyperkalemic blood (HHB) cardioplegia solution regarding their efficacy in myocardial preservation in patients undergoing total repair of non-cyanotic congenital cardiac defects. We assessed postoperative cardiac troponin level, myocardial function, inotropic support, intensive care unit (ICU) length of stay, hospital length of stay, and the incidence of prolonged postoperative mechanical ventilation as indicators of myocardial protection. Results This interventional, single-blinded, randomized, comparative, and prospective clinical study was conducted randomly on 60 patients, aged between 6 and 24 months undergoing total surgical repair. We found no statistically significant difference regarding patients’ personal, demographics, and operative details (surgery duration, cardiopulmonary bypass time, aorta clamp time). However, patients who were given HTK cardioplegia were found to stay less in the ICU (with a p value <0.05). However, there was no statistically significant difference between both groups as regards hospital length of stay. Also, all patients were extubated in less than 24-h duration. There was a statistically significant difference between both groups regarding troponin levels after 8, 12, and 24 h post-bypass in favor of the HHB solution. Interestingly, no significant correlation was proved between both groups regarding myocardial function (EF%, FS) and level of inotropic support (assessed by maximum vasoactive inotropic score). Conclusions Hypothermic hyperkalemic blood cardioplegia showed better results in myocardial preservation than the cold histidine-tryptophan-ketoglutarate solution in the repair of noncyanotic congenital cardiac defects. Trial registration Pan African Clinical Trial Registry, PACTR202109777317416. Registered on 28 September 2021—Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=16154

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“…Custodiol is an intracellular, crystalloid cardioplegia solution that is given in a single dose that lasts for 3 h [ 8 ]. The use of Custodiol in pediatric cardiac surgery is not popular, and there is a paucity of studies comparing Custodiol vs. blood cardioplegia in pediatric patients [ 9 ]. Currently, the efficacy and safety of Custodiol over blood cardioplegia in pediatric cardiac surgery have not been proven.…”

Section: Introductionmentioning

confidence: 99%

Custodiol versus blood cardioplegia in pediatric cardiac surgery: a randomized controlled trial

Elmahrouk,

Shihata,

AL-Radi

et al. 2023

Eur J Med Res

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Background Blood-based cardioplegia is the standard myocardial protection strategy in pediatric cardiac surgery. Custadiol (histidine-tryptophan-ketoglutarate), an alternative, may have some advantages but is potentially less effective at myocardial protection. This study aimed to test whether custadiol is not inferior to blood-based cardioplegia in pediatric cardiac surgery. Methods The study was designed as a randomized controlled trial with a blinded outcome assessment. All pediatric patients undergoing cardiac surgery with cardiopulmonary bypass and cardioplegia, including neonates, were eligible. Emergency surgery was excluded. The primary outcome was a composite of death within 30 days, an ICU stay longer than 5 days, or arrhythmia requiring intervention. Secondary endpoints included total hospital stay, inotropic score, cardiac troponin levels, ventricular function, and extended survival postdischarge. The sample size was determined a priori for a noninferiority design with an expected primary outcome of 40% and a clinical significance difference of 20%. Results Between January 2018 and January 2021, 226 patients, divided into the Custodiol cardioplegia (CC) group (n = 107) and the blood cardioplegia (BC) group (n = 119), completed the study protocol. There was no difference in the composite endpoint between the CC and BC groups, 65 (60.75%) vs. 71 (59.66%), respectively (P = 0.87). The total length of stay in the hospital was 14 (Q2–Q3: 10–19) days in the CC group vs. 13 (10–21) days in the BC group (P = 0.85). The inotropic score was not significantly different between the CC and BC groups, 5 (2.6–7.45) vs. 5 (2.6–7.5), respectively (P = 0.82). The cardiac troponin level and ventricular function did not differ significantly between the two groups (P = 0.34 and P = 0.85, respectively). The median duration of follow-up was 32.75 (Q2–Q3: 18.73–41.53) months, and there was no difference in survival between the two groups (log-rank P = 0.55). Conclusions Custodial cardioplegia is not inferior to blood cardioplegia for myocardial protection in pediatric patients. Trial registration The trial was registered in Clinicaltrials.gov, and the ClinicalTrials.gov Identifier number is NCT03082716 Date: 17/03/2017

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Custodiol cardioplegia solution compared to cold blood cardioplegia in pediatric cardiac surgery: a single-institution experience

Cited by 7 publications

References 22 publications

Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management

Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management

Myocardial protection with histidine-tryptophan-ketoglutarate solution in comparison with hypothermic hyperkalemic blood solution in the correction of acyanotic congenital heart diseases

Custodiol versus blood cardioplegia in pediatric cardiac surgery: a randomized controlled trial

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