Custodiol versus blood cardioplegia in complex cardiac operations: an Australian experience

Viana, Fabiano; Shi, William Y.; Larobina, Marco; Liskaser, Frank; Matalanis, George

doi:10.1093/ejcts/ezs319

Cited by 70 publications

(64 citation statements)

References 14 publications

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“…Although the patients undergoing CABG using SVGs alone had a higher expected operative risk according to EuroSCORE II (P < 0.0001), the use of SVGs alone for myocardial revascularization was a risk factor for hospital death according to the univariable but not the multivariable analysis. Neither the various solutions for myocardial protection nor the various surgical strategies (off-pump, beating heart on-pump, and on-pump technique) that have been used had a different impact on hospital mortality [3,11,16]. Actually, according to the present authors' institutional policy, off-pump and beating heart on-pump techniques were used rarely (9 %) and only in the presence of an unclampable ascending aorta; the single-dose Custodiol-HTK solution was sometimes adopted to reduce the duration of surgery [20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…When a period of myocardial ischemia was used, myocardial protection was usually achieved with multidose cold blood cardioplegia delivered both in an antegrade and retrograde mode. A single-dose crystalloid solution (Custodiol-HTK ® solution; Essential Pharma, Newtown, PA, United States of America) was sometimes preferred, especially when longer ischemic times were expected [16]. Off-pump and beating heart onpump techniques were adopted only in the presence of a diffusely calcified ascending aorta (confirmed by epiaortic ultrasonography scanning) to avoid the risk of cracking atherosclerotic plaques by the aortic crossclamp [17].…”

Section: Surgerymentioning

confidence: 99%

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Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction

et al. 2015

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Despite encouraging improvements, outcomes of coronary artery bypass grafting (CABG) in the presence of left ventricular (LV) dysfunction remain poor. In the present study, the authors' experience on this subject was reviewed to establish the predictors of immediate and long-term results of surgery. Out of 4383 consecutive patients with multivessel coronary artery disease who underwent primary isolated CABG at the authors' institution from January 1999 throughout September 2014, 300 patients (mean age 66.1 ± 9.6 years) suffered preoperatively from LV dysfunction (defined as LV ejection fraction ≤35 %). The mean expected operative risk (EuroSCORE II) was 10.3 ± 13 %. Hospital deaths and perioperative complications were analyzed retrospectively. Outcomes were evaluated during a mean follow-up of 6.2 ± 4 years. None, one or both internal thoracic arteries (ITAs) were used in 6.3, 29 and 64.7 % of cases, respectively. There were 16 (5.3 %) hospital deaths. Prolonged invasive ventilation (17.7 %), acute kidney injury (14.7 %) and multiple blood transfusion (21.3 %) were the most frequent major postoperative complications. The 10-year non-parametric estimates of freedom from all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs) were 47.8 [95 % confidence interval (CI) 44.1-51.5], 65.3 (95 % CI 61.4-69.2), and 42.3 % (95 % CI 38.3-46.3), respectively. Shared predictors of decreased late survival and MACCEs were old age (P < 0.04), chronic lung disease (P < 0.01), chronic dialysis (P < 0.0001) and extracardiac arteriopathy (P < 0.045). After adjustment for corresponding risk factors, freedom from cardiac death was higher when both ITAs were used but only for patients with significant increase of LV ejection fraction early after surgery (P = 0.04). In patients with LV dysfunction, CABG may be performed with acceptable hospital mortality and long-term survival. Late outcomes depend mainly on preoperative characteristics of the patients. The use of both ITAs for myocardial revascularization may give long-term survival benefits but only for patients whose LV function improves significantly early after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Surgerymentioning

confidence: 99%

Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction

et al. 2015

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“…The improvement of myocardium tolerance to ischemia for high-risk patients with complex congenital heart disease is a key issue (3). However, the optimal myocardial protection strategy for high-risk patients with complex congenital heart disease remains controversial (1,4). There are two main groups of cardioplegic solutions; one is based on extracellular components with high potassium, magnesium and bicarbonate levels and the other is based on intracellular electrolytes.…”

Section: Introductionmentioning

confidence: 99%

Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution

Lin

Xiang-wei

Tang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Cardioplegic reperfusion during a long-term ischemic period interrupts cardiac surgery and increases cellular edema due to repeated administration. The present clinical study compared the protective effects of histidine-ketoglutarate-tryptophan (HTK) solution and St. Thomas crystalloid cardioplegia. Clinical experiences of the myocardial protection induced by one single perfusion with HTK were reviewed in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 88 high-risk patients (aortic cross-clamp time, >120 min) between March 2001 and July 2012. The cohort was divided into two groups according to the technique used. Either myocardial protection was performed with one single perfusion with HTK solution (HTK group) or with conventional St. Thomas crystalloid cardioplegia (St group). The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, intensive care unit (ICU) stay, postoperative hospitalization, and transfusions of HTK group are significantly lower than those of the St group (P<0.05). Univariate and multivariate analysis demonstrated that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, the present findings suggested that HTK solution decreases mortality, morbidity, ICU stay, postoperative hospitalization, and transfusions in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease.

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“…This seems to be in accordance also with Braathen et coll. where percentage of patients with LVEF >50% were higher, even if statistically not significant, in the group treated with CCP (12) but not with Viana et al that, on the other hand, reported a lower percentage of patients with impaired cardiac function (Severe LV dysfunction or NYHA > II) in CCP group compared with BCP group (13).…”

Section: Editorialmentioning

confidence: 71%

Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the “arm-wrestling”?

Castaldo¹,

Giordano²,

Palma³

2018

J. Thorac. Dis.

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Custodiol versus blood cardioplegia in complex cardiac operations: an Australian experience

Abstract: The use of Custodiol is convenient, simple and at least as safe as tepid blood cardioplegia for myocardial protection in complex cardiac operations. A randomized prospective comparison of myocardial protection strategies is warranted.

Cited by 70 publications

References 14 publications

Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction

Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction

Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution

Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the “arm-wrestling”?

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