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

Viana, Fabiano F ; Shi, William Y ; Hayward, Philip A ; Larobina, Marco E ; Liskaser, Frank ; Matalanis, George

European journal of cardio-thoracic surgery, 2013-03, Vol.43 (3), p.526-531 [Periódico revisado por pares]

Germany: Oxford University Press

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Título:
Custodiol versus blood cardioplegia in complex cardiac operations: an Australian experience
Autor: Viana, Fabiano F ; Shi, William Y ; Hayward, Philip A ; Larobina, Marco E ; Liskaser, Frank ; Matalanis, George
Assuntos: Aged ; Australia ; Cardiac Surgical Procedures - adverse effects ; Cardiac Surgical Procedures - methods ; Cardiotonic Agents - therapeutic use ; Chi-Square Distribution ; Female ; Glucose - therapeutic use ; Heart Arrest, Induced - adverse effects ; Heart Arrest, Induced - methods ; Humans ; Male ; Mannitol - therapeutic use ; Middle Aged ; Myocardial Reperfusion Injury - drug therapy ; Myocardial Reperfusion Injury - prevention & control ; Organ Preservation Solutions - therapeutic use ; Potassium Chloride - therapeutic use ; Procaine - therapeutic use ; Retrospective Studies ; Treatment Outcome
É parte de: European journal of cardio-thoracic surgery, 2013-03, Vol.43 (3), p.526-531
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descrição: OBJECTIVES A single or dual-dose strategy for myocardial protection is attractive in long operations, in avoiding the need to interrupt the procedure to re-administer cardioplegia. We hypothesized that a single administration of Bretschneider histidine-tryptophan-ketoglutarate (HTK) crystalloid solution (Custodiol) offers myocardial protection comparable with repeated tepid blood cardioplegia. METHODS We reviewed a prospectively compiled single-centre database containing all adult cardiac procedures performed from January 2005 to January 2011. Preoperative demographic and investigative data, operative variables and postoperative (30-day) mortality and morbidity were compared between the Custodiol and blood cardioplegia groups. The study primary endpoints were 30-day mortality, return to the operating theatre, myocardial infarction, stroke, postoperative requirement for an intra-aortic balloon pump, new renal failure, prolonged ventilation and re-admission to hospital within 30 days. Propensity score matching was performed to correct for any bias that may have been associated with the usage of Custodiol. RESULTS A total of 1900 cardiac surgical procedures were identified of which 126 (7%) utilized Custodiol and 1774 (93%) used blood cardioplegia as the primary cardioplegic agent. After propensity-score matching, we were able to match 71 Custodiol cases one-to-one to those receiving blood cardioplegia. There were no statistically significant differences noted for any of the endpoints studied after propensity-score matching. In particular, the proportion of mortality (blood cardioplegia: 1 vs Custodiol 4%, P = 0.63) any mortality/morbidity (blood cardioplegia: 35 vs Custodiol: 39% P = 0.46) was similar between the groups. CONCLUSIONS 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.
Editor: Germany: Oxford University Press
Idioma: Inglês

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

Viana, Fabiano F ; Shi, William Y ; Hayward, Philip A ; Larobina, Marco E ; Liskaser, Frank ; Matalanis, George

Germany: Oxford University Press

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