Key result
Custodiol (HTK) cardioplegia significantly reduced postoperative Troponin I release at 24 hours compared to cold blood cardioplegia (56.5 vs 82.7 ng/ml, p<0.001) in patients undergoing thoracic aortic surgery.
Why the study?
Thoracic aortic operations require extended myocardial ischemic periods, driving the need to evaluate cardioplegic solutions that provide prolonged myocardial protection.
Does single dose HTK cardioplegia reduce post-operative cardiac Troponin I release compared to multiple dose antegrade cold blood cardioplegia in patients undergoing thoracic aortic surgery?
RCT (n=100)
Randomized
No
Does single dose HTK cardioplegia reduce post-operative cardiac Troponin I release compared to multiple dose antegrade cold blood cardioplegia in patients undergoing thoracic aortic surgery?
Absolute Event Rate: 56.5% vs 82.7%
p-value: p=<0.001
Single-dose HTK cardioplegia provides comparable clinical outcomes to cold blood cardioplegia in thoracic aortic surgery, with lower postoperative troponin release and shorter ICU stays, but higher intraoperative hemofiltration and transfusion requirements.
Custodiol and cold blood cardioplegia yield comparable protection in aortic surgery; leaves open any troponin or resource-use advantage pending randomized trials.
Background: Cardiac surgeons demand a cardioplegic solution providing extended durations of myocardial protection due to the increasing complexity of cardiac surgical procedures, especially thoracic aortic operations which require extended myocardial ischemic periods. The goal of this study was to assess the safety and efficacy of cold crystalloid single dosage Histidine Tryptophan Ketogultarate (Custodiol) cardioplegia to cold blood multidose cardioplegia in aortic surgery patients. Methods: Our study included 100 elective and emergency aortic surgery patients. Fifty patients received Custodiol cardioplegic solution (group A) and fifty received cold blood cardioplegia (group B). We evaluated post-operative cardiac Troponin I release, postoperative morbidities and mortality. Results: Troponin I peak release, duration of inotropic support & intensive care unit stay were more in the cold blood group. Hemofiltration and intraoperative requirement of blood products transfusion were more in the Custodiol group. No differences were found regarding cross-clamp time, arrhythmias, postoperative ejection fraction and in-hospital mortality. Conclusion: In patients having thoracic aortic surgery, custodiol and cold blood cardioplegic treatments give good myocardial protection. Custodiol usage was linked to lower troponin levels, shorter inotropic support periods, and shorter ICU stays. In terms of early mortality and morbidity, there was no statistically significant difference between the two groups.
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Dawoud et al. (2022) conducted an RCT in Thoracic aortic surgery (n=100). Bretschneider-HTK solution (Custodiol) vs. Antegrade cold blood cardioplegia was evaluated on Post-operative cardiac Troponin I (cTnI) release at 24 hours (ng/ml) (p=<0.001). Custodiol (HTK) cardioplegia significantly reduced postoperative Troponin I release at 24 hours compared to cold blood cardioplegia (56.5 vs 82.7 ng/ml, p<0.001) in patients undergoing thoracic aortic surgery.
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