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Published on: September 15, 2023
Blood cardioplegia or custodiol for myocardial protection during valvular or aortic surgery: a propensity score
Manuel Carnero-Alcazar1, Lourdes Montero-Cruces2,3, Rosa Beltrao-Sial4
1Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain. mcarneroalcazar@gmail.com.
Insights
Custodiol™ cardioplegia demonstrated better outcomes than blood cardioplegia in valve and aortic surgery. This study found Custodiol™ associated with lower mortality and fewer cardiovascular events, improving patient survival.
Area of Science:
- Cardiovascular Surgery
- Cardiothoracic Anesthesia
- Cardiac Surgery Outcomes
Background:
- Limited evidence exists on Custodiol™ and blood cardioplegia benefits beyond coronary artery bypass grafting.
- Clinical outcomes for these cardioplegia types in valve or aortic surgery require further investigation.
Purpose of the Study:
- To compare mortality and major cardiovascular event risks between Custodiol™ and blood cardioplegia.
- To evaluate the efficacy of different cardioplegia strategies in patients undergoing valve or aortic surgery.
Main Methods:
- Retrospective single-center study of patients undergoing valve or ascending aortic surgery (2016-2024).
- Comparison of Custodiol™ versus blood cardioplegia groups.
- Outcomes adjusted using propensity score matching and IPTW analysis.
Main Results:
- Custodiol™ group showed lower perioperative mortality (2.9% vs. 5.3%) and better long-term survival.
- Custodiol™ was linked to reduced renal failure and low cardiac output syndrome.
- Higher incidence of postoperative atrial fibrillation was observed with Custodiol™.
Conclusions:
- Custodiol™ cardioplegia is associated with improved short- and medium-term survival in on-pump valve and aortic surgery.
- Further research is needed to explore differences in other clinical events.
Background:
There is no solid evidence on the clinical benefits of blood cardioplegia or Custodiol™ in procedures other than coronary artery bypass grafting. We aimed to compare mortality and the risk of major cardiovascular events in patients undergoing valve or aortic surgery.
Methods:
This retrospective single-center study included patients who underwent valve or ascending aortic surgery between 2016 and 2024. The sample was divided based on the type of cardioplegia for myocardial protection: Custodiol™ or blood cardioplegia. The comparison of outcomes between the two groups was adjusted using propensity score.
Results:
2909 patients were included, with 1426 (49%) receiving Custodiol™. In a propensity score-matched analysis that included 930 pairs, we observed higher perioperative mortality in the blood cardioplegia group (5.3% vs. 2.9%, p = 0.014) and worse long-term survival (p = 0.004). In an IPTW analysis, we confirmed significant differences in favor of Custodiol™ for early mortality (-2.2%, 95% CI -4; -0.4), long-term mortality (2.6 years, 95% CI 2.1; 3.2), and renal failure (-4.7%, 95% CI -7.9; -1.6), and low cardiac output syndrome requiring mechanical circulatory support (-2.2%, 95% CI -3.6;-0.9), but a higher siks of postoperative denovo atrial fibrillation (6.8%, 95% CI 2.5;11).
Conclusions:
In this retrospective study including patients undergoing on-pump valve and aortic surgery, Custodiol™ compared to blood cardioplegia was associated with lower short- and medium-term mortality, although no robust evidence was found for differences in other clinical events.
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