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Custodiol cardioplegia solution compared to cold blood cardioplegia in pediatric cardiac surgery: a
Steven Bibevski1, Laura Mendoza1, Mark Ruzmetov1
1Joe DiMaggio Children's Hospital Heart Institute, Hollywood, FL, USA.
Insights
Single-dose Custodiol cardioplegia is as safe as multi-dose blood cardioplegia for myocardial protection in infant congenital heart surgery. This study found no significant differences in cardiac function between the two methods.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Cardioplegia Solutions
Background:
- Custodiol is an intracellular, crystalloid cardioplegia solution offering a single-dose alternative to multi-dose cold blood cardioplegia.
- Limited data exists on Custodiol's efficacy and safety in infants and children undergoing cardiac surgery.
Purpose of the Study:
- To compare the impact of single-dose Custodiol versus multi-dose blood cardioplegia on myocardial function in infants undergoing biventricular repair.
Main Methods:
- A single-center retrospective review of 132 infants (<12 months old) undergoing biventricular repair.
- Patients received either single-dose Custodiol (n=106) or multi-dose blood cardioplegia (n=27).
- Demographic and echocardiographic data, including ejection fraction and fractional area change, were compared.
Main Results:
- No significant differences were observed in cardiopulmonary bypass time or aortic cross-clamp time between the Custodiol and blood cardioplegia groups.
- Pre-operative and post-operative left ventricular ejection fraction and right ventricle fractional area change showed no significant intergroup differences.
- Both groups exhibited similar functional recovery at 24 hours post-op and at discharge.
Conclusions:
- Single-dose Custodiol demonstrates comparable safety and myocardial protection to blood cardioplegia in infant congenital cardiac surgery within the evaluated cross-clamp times.
- Further evaluation at longer cross-clamp times is warranted to fully ascertain the benefits of single-dose Custodiol.
Objective:
Custodiol is an intracellular, crystalloid cardioplegia solution that is a single-dose alternative to multi-dose cold blood cardioplegia; however, there is scarce data regarding its use in infants and children. The objective of this study was to compare its impact on myocardial function in infants.
Methods:
Single-center retrospective review including 132 patients <12 months old undergoing biventricular repair. There were 106 patients who received single-dose Custodiol and 27 patients who received multi-dose blood cardioplegia. Demographic and echocardiographic data were compared between the two groups.
Results:
Patients receiving Custodiol were slightly younger (100 ± 62 days) and lower weight (4.7 ± 1.3 kg) compared to 152 ± 86 days and 5.2 ± 1.3 kg for blood cardioplegia (p < 0.05). The Society of Thoracic Surgeons/European Association for Cardio-Thoracic Surgery Congenital Heart Surgery score was similar between both groups. Average cardiopulmonary bypass time was similar between both groups (Custodiol 93 ± 54 minutes vs. blood 81 ± 44 minutes, p = 0.46) as was aortic cross-clamp time (Custodiol 58 ± 33 minutes vs. cold blood 53 ± 33 minutes, p = 0.62). Pre-operative left ventricular ejection fraction was similar for blood 73 ± 8% versus Custodiol 70 ± 9%, p = 0.21. There was also no intergroup difference in left ventricular ejection fraction 24 hours post op (blood 64 ± 9% vs. Custodiol 65 ± 12%, p = 0.53) or at discharge (blood 66 ± 10% vs. Custodiol 66 ± 11%, p = 0.95). The pre-operative right ventricle function by fractional area change was also similar in blood cardioplegia (46 ± 13%) versus Custodiol (48 ± 9%, p = 0.38) and showed similar drops in parameters in the two groups 24 hours after surgery and at discharge.
Conclusion:
Single-dose Custodiol is as safe as blood cardioplegia for myocardial protection in congenital cardiac surgery for the cross-clamp times evaluated in this study. Evaluation at longer cross-clamp times would be helpful to determine if there is a greater benefit to single-dose Custodiol versus more repeated doses of blood cardioplegia for longer cross-clamp times.
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