Custodiol (Histidine-Tryptophan-Ketoglutarate) Versus Crystalloid (Saint. Thomas) Cardioplegia on Myocardial Protection in Mitral Valve Replacement Surgeries

Background: Cardioplegia is the solution used to arrest and protect myocardial function during cardiac surgery. Cardioplegia is widely used in open-heart surgery. Myocardial protection is a critical approach to reduce the myocardial complications that occur during and after cardiac surgery. Aim: This study was designed to assess the use of custodial (HTK) versus cold crystalloid cardioplegia (Saint-Thomas) on myocardial protection in mitral valve replacement surgeries. METHODS: A total 50 patients undergoing mitral valve replacement surgeries (MVR) aged 25 to 60 years, ASA class II-III was randomly divided into two equal groups: Custodiol (HTK group, n =25) or cold crystalloid cardioplegia (CCC group, n =25) to produce cardiac arrest. RESULT: No significant difference was identified intraoperatively in (ACC time, CPB time, duration of surgery) but there was a significantly higher number of return to a spontaneous rhythm in the custodiol compared to CCC group (56% versus 28%; p = 0.045) and low volume in the HTK group (1412.1 ± 108.7 vs. 1782.9 ± 214.7; p = 0.0001). There were no significant differences between the two groups in CK-MB and troponin I preoperative or postoperatively, but there was a higher increase in their level at 24 h and 48h postoperative in the CCC group versus HTK group. Duration of inotropic support postoperatively significantly higher in the CCC group. CONCLUSIONS: The use of custodiol is effective than cold crystalloid cardioplegia for myocardial protection in mitral valve replacement surgeries Keywords: Mitral valve surgeries; custodial; crystalloid cardioplegia; myocardial protection.