Blood cardioplegia or custodiol for myocardial protection during valvular or aortic surgery: a propensity score adjusted comparison

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.