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Custodiol Solution and Cold Blood Cardioplegia in Arterial Switch Operation: Retrospective Analysis in a Single
Raffaele Giordano1, Luigi Arcieri1, Massimiliano Cantinotti1
1Department of Pediatric Cardiology and Cardiac Surgery, Tuscany Foundation "G. Monasterio," Massa, MS, Italy.
Insights
Custodiol cardioplegia offers favorable cardiopulmonary bypass and aortic cross-clamp times compared to intermittent blood cardioplegia in arterial switch operations. This study found no significant differences in postoperative outcomes or mortality between the two methods.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
- Myocardial Protection
Background:
- Cardioplegia is crucial for myocardial protection during cardiac surgery.
- Arterial switch operations (ASO) require effective myocardial protection strategies.
- Comparing Custodiol solution with intermittent blood cardioplegia in ASO is essential.
Purpose of the Study:
- To compare the efficacy and safety of Custodiol cardioplegia versus intermittent blood cardioplegia in neonates undergoing ASO.
- To evaluate differences in cardiopulmonary bypass times, aortic cross-clamp durations, and postoperative outcomes.
Main Methods:
- Retrospective analysis of 94 neonates undergoing ASO.
- Group 1 (n=44): Intermittent blood cardioplegia (Jan 2008 - Mar 2011).
- Group 2 (n=50): One-shot anterograde Custodiol cardioplegia (Mar 2011 - Nov 2014).
Main Results:
- Custodiol group showed significantly shorter cardiopulmonary bypass and aortic cross-clamp times (p<0.00001).
- No significant differences in delayed sternal closure, 30-day mortality, or transient ischemic electrocardiogram events.
- A trend towards higher peak troponin-I and brain natriuretic peptide levels was observed in the Custodiol group.
Conclusions:
- Custodiol cardioplegia does not appear to cause additional myocardial damage in ASO.
- Custodiol cardioplegia may simplify the surgical procedure and enhance surgeon comfort.
- Further research may be warranted to explore the observed biomarker trends.
Background:
The cardioplegia is one of the most significant tools used to increase myocardial protection. The aim of our study is to compare the use of Custodiol solution versus intermitted blood cardioplegia in a retrospective analysis of data for patients who underwent arterial switch operation in our institution.
Material And Methods:
From January 2008 to March 2011, myocardial protection was performed in 44 neonates (blood group) with intermittent blood cardioplegia. From March 2011 to November 2014, myocardial protection was performed in 50 neonates (Custodiol group) with one-shot anterograde Custodiol cardioplegia.
Results:
Cardiopulmonary bypass and aortic cross-clamp were more favorable in Custodiol group (p-value 0.005 and ≤ 0.00001). The rate of delayed sternal closure was 63.6% in the blood group and 52% in the Custodiol group (p = 0.25). In the postoperative outcomes we did not find differences between the two groups. The 30-day mortality was one patient in the blood group (p = 0.46). We observed a transient ischemic electrocardiogram in 10 patients of the blood group and in 14 of the Custodiol group (p = 0.72), all cases with full resolution during hospitalization without coronary reoperation. A trend of higher peak of troponin-I and brain natriuretic peptide in Custodiol group has been reported.
Conclusion:
No prefect cardioplegia exists, the Custodiol solution does not cause extra/additional myocardial damage in arterial switch operation. In our experience this strategy seems warranted to simplify the procedure and to be more comfortable for the surgeon.
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