Comparison between Bretschneider -HTK solution and antegrade cold blood cardioplegia as a method for myocardial protection in thoracic aortic surgery

Abstract

Background: Cardiac surgeons demand a cardioplegic solution providing extended durations of myocardial protection due to the increasing complexity of cardiac surgical procedures, especially thoracic aortic operations which require extended myocardial ischemic periods. The goal of this study was to assess the safety and efficacy of cold crystalloid single dosage Histidine Tryptophan Ketogultarate (Custodiol) cardioplegia to cold blood multidose cardioplegia in aortic surgery patients. Methods: Our study included 100 elective and emergency aortic surgery patients. Fifty patients received Custodiol cardioplegic solution (group A) and fifty received cold blood cardioplegia (group B). We evaluated post-operative cardiac Troponin I release, postoperative morbidities and mortality. Results: Troponin I peak release, duration of inotropic support & intensive care unit stay were more in the cold blood group. Hemofiltration and intraoperative requirement of blood products transfusion were more in the Custodiol group. No differences were found regarding cross-clamp time, arrhythmias, postoperative ejection fraction and in-hospital mortality. Conclusion: In patients having thoracic aortic surgery, custodiol and cold blood cardioplegic treatments give good myocardial protection. Custodiol usage was linked to lower troponin levels, shorter inotropic support periods, and shorter ICU stays. In terms of early mortality and morbidity, there was no statistically significant difference between the two groups.