Custodial-HTK Solution for Myocardial Protection in CABG Patients

Area of Science:

• Cardiovascular Surgery
• Cardiothoracic Medicine
• Myocardial Preservation

Background:

• Myocardial preservation is critical during open-heart surgery, with cardioplegia solutions playing a key role.
• Cardioplegia solutions are broadly classified as intracellular (e.g., HTK) or extracellular (e.g., blood cardioplegia).
• Intracellular solutions offer longer protection periods (3-4 hours) after a single infusion compared to extracellular solutions requiring frequent redosing.

Purpose of the Study:

• To compare the efficacy of Custodiol-HTK (intracellular) and blood cardioplegia (extracellular) for myocardial protection during Coronary Artery Bypass Graft (CABG) surgery.
• To evaluate clinical outcomes and complications associated with each cardioplegia type.

Main Methods:

• A retrospective case-control study involving 125 CABG patients.
• Patients were divided into two groups: Group A (blood cardioplegia) and Group B (Custodiol-HTK).
• Analysis included baseline data, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, defibrillation rates, ICU stay, length of stay, and mortality.

Main Results:

• The study included 60 patients in Group A and 65 in Group B.
• Spontaneous ventricular fibrillation after cross-clamp release was significantly higher in the HTK group (33.8%) compared to the blood cardioplegia group (8.3%).
• Mortality rates were 1.7% for blood cardioplegia and 4.6% for HTK. Other postoperative complications were similar between groups.

Conclusions:

• Single-dose antegrade cold Custodiol-HTK cardioplegia provides myocardial protection comparable to repetitive antegrade cold blood cardioplegia in CABG surgery.
• Despite a higher incidence of ventricular fibrillation in the HTK group, overall clinical outcomes suggest equivalent myocardial protection.