Custodiol versus cold blood cardioplegia for myocardial protection in double valve surgeries

Optimal myocardial protection (MP) remains critical in complex cardiac procedures, particularly double valve replacement (DVR) operations. This study aimed to compare the safety and efficacy of Custodiol versus cold blood cardioplegia (CBCP) for MP in DVR surgeries.

A prospective, non-randomized controlled trial was conducted on 120 adult cases (aged 18-65 years) undergoing elective DVR surgery. Patients were allocated to receive either Custodiol cardioplegia (group A, n = 60) or CBCP (group B, n = 60). Primary outcomes included postoperative cardiac enzyme levels, mechanical ventilation (MV) duration, and intensive care unit (ICU) stay. Secondary outcomes encompassed postoperative complications, mortality, and hospital stay (HS).

Custodiol cardioplegia demonstrated superior operative efficiency with shorter aortic cross-clamp (ACC) time (98.5 ± 36.1 versus 116.1 ± 38.0 min, p = 0.010). Creatine kinase-MB (CK-MB) levels were notably lower in the Custodiol group (11.90 ± 4.30 versus 13.60 ± 3.40 U/L, p = 0.017), while troponin I levels showed no substantial variation. Custodiol patients experienced shorter ICU stay (3.12 ± 1.10 versus 4.22 ± 1.20 days, p < 0.001) and HS (8.24 ± 1.03 versus 13.39 ± 3.09 days, p < 0.001). However, spontaneous ventricular fibrillation (VF) rates were higher with Custodiol (86.6% versus 26.6%, p < 0.001).

Custodiol cardioplegia provides effective MP in DVR surgery with superior clinical outcomes, including reduced ischemic time and HS, despite increased VF rates.

The online version contains supplementary material available at 10.1007/s12055-025-02126-z.