A comparative study between custodiol and warm blood cardioplegia in coronary artery bypass graft operation with poor left ventricular function

Abstract

Background Cardioplegia is responsible for myocardial protection during open heart surgery. Cardioplegia was first presented as an agent for hypothermic hyperkalemic arrest. Blood was then introduced as a vehicle to convey potassium to the heart. Custodiol Histidine-Tryptophan- ketoglutarate (HTK) solution is safe and used as a single dose, which can last for up to 3 h. The comparison of the clinical outcomes of this particular solution with warm blood cardioplegia in coronary artery bypass graft (CABG) with poor left ventricular (LV) function has received little attention. Objective To compare the clinical outcomes of custodiol solution with warm blood cardioplegia in CABG with poor LV function. Patients and methods This single-center randomized prospective study was carried out from January 2017 till January 2018, at National Heart Institute of Egypt. Overall, 50 patients with poor LV function undergoing isolated CABG were divided randomly according to type of myocardial protection during revascularization into two groups: group A included 25 patients who received warm blood cardioplegia, and group B included 25 patients who received custodiol cardioplegia. Data from each group were collected and compared with each other. Results Baseline demographic and intraoperative data showed no significant difference between the two groups. The need for intra-aortic balloon pump was similar in both groups. The need for inotropic support, length of mechanical ventilation, and ICU stay was statistically nonsignificant between the two groups. Postoperative arrhythmia was significantly higher in custodiol group [nine (34.62%)] compared with warm blood group [two (8%)] (P = 0.021). Overall mortality shows a statistically nonsignificant difference. Improvement in left ventricular ejection fraction after surgical revascularization was observed among both groups. Conclusion Both custodiol cardioplegia and warm blood cardioplegia offer a satisfactory method for myocardial protection in low ejection fraction ischemic heart disease, with increased incidence of postoperative arrhythmia in custodiol cardioplegia.