73. Custodiol versus blood cardioplegia in pediatric cardiac surgery

Abstract

Cardioplegia is a solution used to arrest and protect the heart during open cardiac repair with the use of cardiopulmonary-bypass. Two types of cardioplegia were evaluated. Blood cardioplegia and HTK crystalloid cardioplegia known as Custodiol. Objectives: To evaluate the efficacy of myocardial protection with antegrade intermittent oxygenated blood cardioplegia in comparison to a single dose of Custodiol in pediatric cardiac surgery. Methods: A retrospective cohort study was performed between November 1st, 2013 and June 30th, 2014. Fifty-two patients underwent congenital heart procedure at King Abdul-Aziz University Hospital with the use of cardiopulmonary-bypass and cardioplegia. Forty-two received blood cardioplegia and ten received Custodiol. Data were collected from operative reports, electronic and paper charts. Statistical analysis was done using Pearson-test for continuous data and Kruskal–Wallis-test for categorical data. P-Value of 0.05 was considered significant. Results: Patients in the Custodiol group experienced longer duration of cardiopulmonary-bypass time (median value of 84 versus 77.5 min), aortic clamping time (63 versus 50.5 min) and total operation time (175 versus 144 min), compared to the Blood group. The duration of mechanical ventilation was longer in the Custodial group, 72 versus 48 h in the Blood group (p = 0.016). The incidence of post-operative arrhythmia requiring treatment was also higher in Custodiol group, 50% versus 12% in the Blood group (p = 0.02). Low output syndrome, acute kidney injury and death were not statistically significantly different between two groups. Conclusions: Custodiol may have inferior myocardial protection compared to blood cardioplegia in children undergoing cardiac surgery. A randomized comparison is warranted.