Custodiol (Histidine-Tryptophan-Ketoglutarate) versus Modified St. Thomas Cold Crystalloid Cardioplegia: Short-term Results

Background: Myocardial protection refers to strategies used to avoid post-ischemic myocardial dysfunction. One dose approach for myocardial safety is attractive in long operations. Purpose: to assess differences among the custodial cardioplegia and the cold crystalloid cardioplegia according to myocardial protection in cases listed for Double Valve Replacement Surgery. Patient and methods: This prospective cohort trial included 50 cases had double valve replacement surgery between August 2017 and July 2019. Twenty-nine patients were males (58%), and the mean age was 57.66±8.81 years. The mean ejection fraction was 41.43±9.25 %. Results: The mean CPB time in custodial group was 99.4±8.46 while in cold crystalloid cardioplegia group was 95.6±12.27 minutes. The mean DC shocks that was required in custodial group was 9(36%) while in cold crystalloid cardioplegia group was 17 (68%) times. Mean days of ICU stay in custodial group were 1.28±0.46 while in cold crystalloid cardioplegia group were 1.72±0.61 days. The mean duration of mechanical ventilation in custodial group was 4.64±0.86 while in cold crystalloid cardioplegia group was 7.04±0.84 hours. Troponin elevation mean in the immediate post-operative: in custodiol group was 8.46±2.21 while in the cold crystalloid group was 10.08±2.18. Conclusion: This study showed that the evidence supporting the superiority of custodial over cold crystalloid cardioplegia are limited however, Custodiol cardioplegia is appealing as it gives lengthy myocardial protection with a single-dose. The present work demonstrated that Histidine-Tryptophan-Ketoglutarate cardioplegia is related with less ICU stay, mechanical ventilation, postoperative hospitalization and troponin T release in low-risk patients who had double valve replacement.