Safe cross-clamp time using Custodiol^®–histidine-tryptophan-ketoglutarate cardioplegia in the adult

Abstract

Introduction: Safe cross-clamp time using single-dose Custodiol®–histidine-tryptophan-ketoglutarate cardioplegia has not been established conclusively. Methods: Immediate post-operative outcomes of 1,420 non-consecutive, cardiac surgery patients were reviewed retrospectively. Predictors of a combined endpoint made of in-hospital mortality and any major complication post-surgery were found with the multivariable method. Analysis of variance was used to evaluate the impact of cross-clamp time on most relevant complications. Discriminatory power and cut-off value of cross-clamp time were established for in-hospital mortality and each of the major complications (receiver operating characteristic curve analysis). A comparative analysis (with propensity matching) with multidose cold blood cardioplegia on in-hospital mortality post-surgery was performed in non-coronary surgery patients. Results: Coronary, aortic valve and mitral valve surgery and surgery on thoracic aorta were performed in 45.4%, 41.9%, 49.5%, 20.6% of cases, respectively. In-hospital mortality and the rate of any major complication post-surgery were 6.5% and 41.9%, respectively. Cross-clamp time had significant impact on in-hospital mortality and almost all major post-operative complications, except neurological dysfunctions (p = 0.084), myocardial infarction (p = 0.12) and mesenteric ischaemia (p = 0.85). Areas under the receiver operating characteristic curve and the optimal cut-off values for in-hospital mortality and any major complication were of 0.657, 0.594, >140 and >127 minutes, respectively. Comorbidities-adjusted odds ratio for any major complication of cross-clamp time <127 minutes was 1.86 (p < 0.0001). Despite similar in-hospital mortality (p = 0.57), there was an earlier significant increase of mortality in Custodiol–HTK than in multidose cold blood propensity-matched, non-coronary surgery patients. Conclusions: The use of Custodiol–HTK cardioplegia is associated with a low risk of serious post-operative complications provided that cross-clamp time is of 2 hours or less.

Safety of Custodiol cardioplegia: a cohort study in patients undergoing cardiac surgery with elongated aortic cross-clamp time

“…For this reason, Custodiol is generally used during complex cardiac surgery with expected prolonged aortic cross-clamp times. In the study of Gatti et al, 24 Custodiol was associated with low incidence of serious postoperative complications including myocardial infarction, cerebro-vascular accident and low cardiac output. Custodiol has two free radical scavengers, mannitol and histidine, which results in a relatively low risk of ischemic reperfusion injury.…”

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia

“…HTK, developed by the German physiologist Hans Jürgen Bretschneider at the University of Göttingen in the early 1970s (branded as Custodiol ® by Essential Pharmaceuticals, Durham, NC, USA, has been proposed as a substitute for blood agents and other conventional cardioplegias, with up to 3 h of myocardial protection in conjunction with hypothermia [ 35 , 36 , 37 ]. Surgeons can tackle laborious interventions (they gain time by reducing the total time of administering cardioplegia) [ 38 , 39 , 40 , 41 , 42 ]. For a significant period of time, this type of cardioplegia was forgotten.…”

Bilateral Internal Thoracic Artery Grafting Concomitant With Other Cardiac Operations ― Insights From a European Multicenter Retrospective Study on 1,123 Consecutive Patients ―

“…Both ITAs were dissected as skeletonized conduits, and the ITA harvesting technique did not change in the 3 centers during the study period (Supplementary Methods). 5,[7][8][9][10][11][12][13]17,26,27 All coronary anastomoses on the inferolateral cardiac wall were performed before any other surgical procedure that involved cardiac valves, the left ventricle, or thoracic aorta. Cardiac tumor removal and operations for arrhythmias were included in the study.…”