custodial long time for myocardial preservation

2. Custodiol-HTK Solution Vs. Conventional
Cardioplegia for Myocardial Protection During
Coronary Artery Bypass Grafting Following Recent
ST-Elevation Myocardial Infarction
Walaa Saber*, Mohamed El-Ghannam*, Yasser Mubarak** , Hesham Mahdy ** ,
Ramy Khorshid*
Department of Cardiothoracic Surgery, Faculty of Medicine,
*Ain Shams University, Egypt,
** Minia University, Egypt

3. Introduction
Early coronary artery bypass grafting (CABG) within 24-hr of recent
ST-elevation myocardial infarction (STEMI) can be performed as a
primary reperfusion therapy after failed PCI or when non-indicated.
Proper myocardial protection with cardioplegic solutions is an
essential step during cardiac surgery, especially in elderly patients and
with severe conditions.

4. Custodiol (HTK) is an intracellular crystalloid cardioplegia which is
claimed to offer single shot for myocardial protection during complex
cardiac procedures for up to 3-hr.
We aimed to compare the clinical outcome of early CABG using blood
cardioplegia vs. Custodiol solution for myocardial protection in patients
with recent STEMI.

5. Materials and Methods
This prospective comparative study included 100 patients with recent
STEMI who underwent early CABG.
The patients were divided into two groups:-
group A (n = 50) received blood cardioplegia and
group B (n = 50) received Custodiol-HTK crystalloid cardioplegia.

6. Key eligibility Criteria
Adult patients of both genders,
Undergoing isolated on-pump CABG,
Recent STEMI within 1-month before surgery,
and failed or unavailable PCI.

7. Exclusion Criteria
Patients with previous CABG,
Concomitant cardiac procedure,
Pre-operative intra-aortic balloon pump (IABP),
Child-C liver diseases, renal impairment, or cardiogenic shock.

8. Results
There were non-significant differences in postoperative mortality and
complication rates between both the groups except for significantly
higher proportion of postoperative arrhythmias after Custodiol
cardioplegia (26% vs. 8%, P = 0.01).

9. Post-operative outcome
Inotropic support >24 h, n (%) 21 (42) 12 (24) 0.056
Re-opening for bleeding, n (%) 2 (4) 1 (2) 0.55
Arrhythmia, n (%) 4 (8) 13 (26) 0.01
Renal dysfunction, n (%) 1 (2) 0 (0) 0.31
Pulmonary complications, n (%) 2 (4) 1 (2) 0.55
Neurological complications, n (%) 2 (4) 1 (2) 0.55
Gastrointestinal complications, n (%) 0 (0) 1 (2) 0.31
Wound infection, n (%) 1 (2) 1 (2) 1
30-day mortality, n (%) 2 (4) 1 (2) 0.55
Mechanical ventilation (h) 18.28 ± 8.84 11.98 ± 4.03 <0.001
ICU stay (h) 80.20 ± 19.91 70.04 ± 14.80 0.01
Post-operative hospital stay (days) 9.24 ± 3.41 7.98 ± 2.76 0.06
Troponin 1 h (ng/mL), mean±SD 0.474 ± 0.094 0.436 ± 0.087 0.04
Troponin 6 h (ng/dL), mean±SD 0.581 ± 0.093 0.536 ± 0.081 0.02
Troponin 12 h (ng/dL), mean±SD 0.415 ± 0.073 0.415 ± 0.072 0.95
Troponin 24 h (ng/mL), mean±SD 0.400 ± 0.060 0.405 ± 0.059 0.62
Lactate 1 h (mmol/L), mean±SD 1.56 ± 0.47 1.78 ± 0.44 0.02
Lactate 6 h (mmol/L), mean±SD 1.80 ± 0.61 2.04 ± 0.55 0.04
Lactate 12 h (mmol/L), mean±SD 1.51 ± 0.28 1.58 ± 0.28 0.19
Lactate 24 h (mmol/L), mean±SD 0.98 ± 0.30 1.06 ± 0.27 0.20

10. Primary End Point
There was no significant difference between both the groups with
regard to comparison of inotropic support >24-hr, re-opening for
bleeding, renal dysfunction, pulmonary complications, neurological
complications, GI complications, wound infection, and 30-day mortality.

11. • Custodiol group had significantly shorter duration of mechanical
ventilation (11.98±4.03 vs. 18.28±8.84 hr) .
• However, there was a significant higher incidence of VF (26% vs. 8%).

12. mean and range of post-operative troponin levels within 24 h after surgery in the studied groups

13. Custodiol was associated with significantly lower levels of blood
troponin and higher levels of blood lactate for 6-hr after CABG.

14. Conclusion
Custodiol as a single shot without interruption of the operative
technique offers shorter durations of mechanical ventilation and ICU
stay than blood cardioplegia, with more acceptable levels of post-
operative troponin in high-risk patients who underwent early CABG for
recent STEMI.