Protección miocárdica mediante cardioplejia Custodiol® frente a cristaloide convencional en cirugía cardíaca compleja. Resultados de una serie institucional

Abstract

IntroductionCustodiol® cold crystalloid cardioplegia offers myocardial protection for up to three hours with one single dose, allowing to perform complex procedures without interruption. There is concern about the adequacy of single dose cardioplegia in terms of myocardial protection. ObjectiveTo compare results of perioperative morbidity and mortality of conventional crystalloid cardioplegia used in our hospital (St.Thomas 2 [ST2]) versus Custodiol in complex cardiac surgery. MethodsA retrospective comparative study was conducted between patients who underwent cardiac surgery with aortic cross-clamping times over 80 minutes, from May 2016 until December 2019. They were divided into two groups of cardioplegia: ST2 group versus Custodiol group. ResultsThe study included 712 patients, of whom 548 were in ST2 group and 164 in Custodiol group. Preoperative variables showed a greater number of women, re-interventions, and emergent cases, with the highest EuroSCORE ii (4.90% vs. 7.19%, p = 0.000) in the Custodiol group.The Custodiol group also had longer cardiopulmonary bypass times (127 vs. 149 minutes, p = 0.000) and aortic cross-clamping times (106 vs. 124 minutes, p = 0.0001), and a greater number of ventricular arrhythmias that needed defibrillation (16.2% vs. 34.6%, p = 0.000).Surgical mortality did not show any differences (3.8% vs. 6.1%, p = 0.152). Hospital stay was two days longer in the Custodiol group.In multivariate analysis, type of cardioplegia did not result in an independent risk factor for post-operative morbidity and mortality. ConclusionsThis hospital centre proposes the use of Custodiol in complex cardiac surgery with prolonged aortic cross-clamping times as a safe alternative to conventional crystalloid cardioplegia, as it offers good myocardial protection for surgeons, with same incidence of post-operative complications.