Custodiol versus blood cardioplegia in complex cardiac operations

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Information about Custodiol versus blood cardioplegia in complex cardiac operations
Health & Medicine

Published on February 20, 2014

Author: yosaadi

Source: slideshare.net

Custodiol versus blood cardioplegia in complex cardiac operations: an Australian experience 1. 2. 3. 4. 5. 6. Fabiano F. Vianaa,*, William Y. Shib, Philip A. Haywardb, Marco E. Larobinab, Frank Liskaserc and George Matalanisb + Author Affiliations 1. 2. 3. a Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Australia Department of Cardiac Surgery, Austin Hospital, Melbourne, Australia c Department of Anaesthesia, Austin Hospital, Melbourne, Australia b 1. ↵*Corresponding author. Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Australia. Tel: +61-3-95944515; fax: +61-3-95946248; e-mail: ff_viana@hotmail.com (F.F. Viana). Received February 5, 2012. Revision received April 21, 2012. Accepted April 25, 2012. Abstract OBJECTIVES A single or dual-dose strategy for myocardial protection is attractive in long operations, in avoiding the need to interrupt the procedure to re-administer cardioplegia. We hypothesized that a single administration of Bretschneider histidine–tryptophan–ketoglutarate (HTK) crystalloid solution (Custodiol) offers myocardial protection comparable with repeated tepid blood cardioplegia. METHODS We reviewed a prospectively compiled single-centre database containing all adult cardiac procedures performed from January 2005 to January 2011. Preoperative demographic and investigative data, operative variables and postoperative (30-day) mortality and morbidity were compared between the Custodiol and blood cardioplegia groups. The study primary endpoints were 30-day mortality, return to the operating theatre, myocardial infarction, stroke, postoperative requirement for an intra-aortic balloon pump, new renal failure, prolonged ventilation and re-admission to hospital within 30 days. Propensity score matching was performed to correct for any bias that may have been associated with the usage of Custodiol. RESULTS A total of 1900 cardiac surgical procedures were identified of which 126 (7%) utilized Custodiol and 1774 (93%) used blood cardioplegia as the primary cardioplegic agent. After propensity-score matching, we were able to match 71 Custodiol cases one-to-one to those receiving blood cardioplegia. There were no statistically significant differences noted for any of

the endpoints studied after propensity-score matching. In particular, the proportion of mortality (blood cardioplegia: 1 vs. Custodiol 4%, P = 0.63) any mortality/morbidity (blood cardioplegia: 35 vs. Custodiol: 39% P = 0.46) was similar between the groups. CONCLUSIONS The use of Custodiol is convenient, simple and at least as safe as tepid blood cardioplegia for myocardial protection in complex cardiac operations. A randomized prospective comparison of myocardial protection strategies is warranted. TUJUAN Sebuah strategi tunggal atau dual-dosis untuk perlindungan miokard menarik dalam operasi yang panjang, dalam menghindari kebutuhan untuk mengganggu prosedur untuk kembali mengelola cardioplegia. Kami berhipotesis bahwa administrasi tunggal dari solusi Bretschneider histidintryptophan-ketoglutarat (HTK) kristaloid (Custodiol) menawarkan perlindungan miokard sebanding dengan cardioplegia darah berulang hangat. METODE Kami meninjau database tunggal-pusat prospektif disusun berisi semua prosedur jantung dewasa yang dilakukan dari Januari 2005 hingga Januari 2011. Data demografi dan investigasi preoperatif, variabel operasi dan pasca operasi (30 hari) mortalitas dan morbiditas dibandingkan antara Custodiol dan golongan darah cardioplegia. Titik akhir penelitian primer adalah mortalitas 30-hari, kembali ke ruang operasi, infark miokard, stroke, persyaratan pasca operasi untuk pompa balon intraaorta, gagal ginjal baru, ventilasi berkepanjangan dan re-masuk ke rumah sakit dalam waktu 30 hari. Kecenderungan skor pencocokan dilakukan untuk mengoreksi bias yang mungkin telah dikaitkan dengan penggunaan Custodiol. HASIL Sebanyak 1900 prosedur bedah jantung diidentifikasi dari mana 126 (7%) digunakan Custodiol dan 1.774 (93%) digunakan cardioplegia darah sebagai agen kardioplegik utama. Setelah kecenderungannilai pencocokan, kami mampu untuk mencocokkan 71 kasus Custodiol satu-ke-satu untuk mereka yang menerima cardioplegia darah. Tidak ada perbedaan yang signifikan secara statistik dicatat untuk salah satu endpoint dipelajari setelah kecenderungan-skor pencocokan. Secara khusus, proporsi kematian (darah cardioplegia: 1 vs Custodiol 4%, P = 0,63) setiap mortalitas / morbiditas (darah cardioplegia: 35 vs Custodiol: 39% P = 0,46) adalah serupa antara kelompok. KESIMPULAN Penggunaan Custodiol nyaman, sederhana dan paling aman seperti cardioplegia darah hangat untuk perlindungan miokard dalam operasi jantung kompleks. Sebuah perbandingan prospektif acak dari strategi perlindungan miokard dibenarkan.

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