Comparison of Custodiol® and modified St. Thomas cardioplegia for myocardial protection in coronary artery bypass grafting

Abstract

Background/Aim. Custodiol® is a hyperpolarizing cardio-plegic solution which has been used in our national cardiac surgical practice exclusively for the heart transplant surgery. Owing to its numerous advantages over the standard depo-larizing solutions, Custodiol® became cardioplegic solution of choice for all other cardiac surgical procedures in many cardio-surgical centers. This study evaluated myocardial pro-tection by Custodiol® compared to modified St. Thomas cardioplegic solution in coronary artery bypass surgery. Methods. In a prospective four-month study, 110 consecu-tive adult patients who underwent primary isolated elective on-pump coronary artery bypass grafting (CABG) were randomized into the Custodiol® group (n = 54) and the St. Thomas groupa (n = 50), based on the type of administered cardioplegia; six patients were excluded. Cardiac protection was achieved as antegrade cold crystalloid cardioplegia by one of the solutions. Myocardial preservation was assessed through following outcomes: spontaneous rhythm restora-tion post cross-clamp, and postpoperative cardiac specific enzymes level, ejection fraction (EF) change, inotropic sup-port, myocardial infarction (MI), atrial fibrillation (AF), and death. Results. Preoperative and intraoperative characteris-tics of patients in both groups were similar except for a considerably longer cross-clamp time in the Custodiol® group (49.1 ± 19.0 vs. 41.0 ± 12.9 minutes; p = 0.022). The Custodiol® group exhibited a higher rate of return to spon-taneous rhythm compared to the St. Thomas group (31.5% vs. 20.0%, respectively; p = 0.267), lower rates of AF (20.4% vs. 28%, respectively; p = 0.496), MI (1.8% vs. 10.0%, respectively; p = 0.075) and inotropic support (9.0% vs. 12.0%, respectively; p = 0.651), albeit not statistically significant. There was an insignificant difference in peak value of troponin I between the Custodiol® and Thee St. Thomas group (5.0 ± 3.92 μg/L vs. 4.5 ± 3.39 μg/L, re-spectively; p = 0.755) and creatine kinase-MB (26.9 ± 15.4 μg/L vs. 28.5 ± 24.2 μg/L, respectively; p = 0.646) 6 hours post-surgery. EF reduction was comparable (0.81% vs. 1.26%; p = 0.891). There were no deaths in both groups. Conclusions. Custodiol® and modified St. Thomas cardio-plegic solution have comparable cardioprotective effects in CABG surgery. The trends of less frequent MI, AF and ino-tropic support, despite the longer cross-clamp time in the Custodiol® group may suggest that its benefits could be as-certained in a larger study.