CUSTODIOL | Blood-based | |
---|---|---|
Composition | K+ low, Na+ low | K+ high, Na+ low |
Incidence of ventricular Arrhythmia1) |
33% | 72% |
Spontaneous Defibrillation1),2),4) |
90% | 26% |
Oedema formation3) | 27% | 54% |
Mortality rate4) | 1% | NN |
Cross clamp period without repeat cardioplegia4),5) |
120-180 minutes | Repeated doses of cardioplegia (<20min) |
Transplantation | yes | no |
1) Hachida M, Nonoyama M, Bonkohara Y, Hanayama N, Saitou S, Maeda T, Ohkado A, Lu H, Koyanagi H. Clinical assessment of prolonged myocardial preservation for patients with a severely dilated heart. Ann Thorac Surg. 1997 Jul;64(1):59-63.
2) Sakata J, Morishita K, Ito T, Koshino T, Kazui T, Abe T. Comparison of clinical outcome between histidine-triptophan-ketoglutalate solution and cold blood cardioplegic solution in mitral valve replacement. J Card Surg. 1998 Jan;13(1):43-7.
3) Kim S, Lee YS, Woo JS, Sung SH, Choi PJ, Cho GJ, Bang JH, Roh MR, Histidinetryptophan-ketoglutarate Versus Blood Cardioplegic Solutions: A Prospective, Myocardial Ultrastructural Study. Korean J Thorac Cardiovasc Surg 2007;40:8-16
4) Misfeld M, Davierwala P. Crystalloid-based cardioplegia for minimally invasive cardiac surgery. Semin Thorac Cardiovasc Surg. 2012 Winter;24(4):305-7.
5) Matzelle SJ, Murphy MJ, Weightman WM, Gibbs NM, Edelman JJ, Passage J. Minimally invasive mitral valve surgery using single dose antegrade Custodiol cardioplegia. Heart Lung Circ. 2014 Sep;23(9):863-8.
A single dose of antegrade CUSTODIOL crystalloid cardioplegia is a safe and effective strategy to protect the myocardium during Minimal Invasive Valve Surgery6)
Operative data | Evaluation |
---|---|
In-hospital mortality | 0% |
ICU stay | Short |
Myocardial cytonecrosis enzymes (CK-MB, Lactate) | No significant increase was found |
Inotropic support >24 h | Mild-to-moderate postoperative support |
Neurologic complications | Only one patient (not related to HTK) |
Occurrence of renal complications | Very low |
Incidence of AF (postoperative atrial fibrillation) | Low |
Overall clinical outcomes | Excellent |
After aortic occlusion, one single dose of CUSTODIOL solution is delivered for a period of 6 to 8 minutes (20-25mL/kg) into the aortic root with a perfusion pressure (aortic root pressure) of 40 to 60mmHg. No additional cardioplegic doses are required Hemodilution after a large volume of cardioplegia infusion is an important point. To maintain a stable hemoconcentration during the perioperative period, a careful ultrafiltration during extracorporeal circulation as well as a strict use of diuretic drugs in intensive care and ward units was used. This approach enabled the authors to use a minimal amount of blood transfusion during the postoperative course
6) Savini C, Murana G, Di Eusanio M, Suarez SM, Jafrancesco G, Castrovinci S, Castelli A, Di Bartolomeo R. Safety of single-dose histidine-tryptophan-ketoglutarate cardioplegia during minimally invasive mitral valve surgery. Innovations (Phila). 2014 Nov-Dec;9(6):416-20.
The usage of CUSTODIOL helps minimizing the frequency of interruptions of the surgical procedure7)
CUSTODIOL | Blood group | |
---|---|---|
Number of doses given | 1 | 5 |
Cardiopulmonary bypass time (min) | 160 | 188 |
Aortic cross-clamp time (min) | 93 | 112 |
Mortality at 30 d (%) | 0 | 2.3 |
Total hospital stay | 23 | 25 |
Blood and metabolic outcomes were equal. Typically, in the CUSTODIOL group, TnI level had a peak in the early hours after CPB with a rapid decrease within the first 24 hours CUSTODIOL was infused anterograde according to the following protocol: temperature 5 to 8°C; 1ml of solution per minute and per gram estimated heart weight (infant ≈ 0.6% of bodyweight); and perfusion pressure initially 80 to 90mmHg, after cardiac arrest 30 to 40mmHg for 6 minutes. The right atrium was opened and the cardioplegia was completely aspirated outside the bypass circuit to avoid hemodilution
7) Giordano R, Arcieri L, Cantinotti M, Pak V, Poli V, Maizza A, Melo M, Assanta N, Moschetti R, Murzi B. Custodiol Solution and Cold Blood Cardioplegia in Arterial Switch Operation: Retrospective Analysis in a Single Center. Thorac Cardiovasc Surg. 2016 Jan;64(1):53-8.
Efficacy confirmed in more than 1290 Heart Transplant Recipients 8)
Cold Ischemia Time (CIT) | |
---|---|
Median | 194.4 min |
Standard deviation | ±40.4 min |
30-day mortality | |
Overall | 9% |
CIT > 240 min | 13% |
Data recorded between 1989 and early 2004 at a single transplant centre (Bad Oeynhausen, Germany) where the greatest number of heart transplants in the world were performed during that time. These data represent the entire experience of the centre, with no cases excluded.
Donor heart procurement was performed as follows: At the time of explantation, 50ml/kg body weight of CUSTODIOL was used for flushing and the heart was stored in 1000ml of CUSTODIOL. Following cross-clamping of the ascending aorta, the perfusion pressure of CUSTODIOL was maintained at 60mmHg initially, and maintained at 40mmHg for a period of 7 minutes after cardiac arrest. This follows a perfusion rate of 1ml/min per gram of heart weight, up to a total amount of 3000 to 4000ml used for adults
8) Tjang YS, van der Heijden GJ, Tenderich G, Grobbee DE, Körfer R. Survival analysis in heart transplantation: results from an analysis of 1290 cases in a single center. Eur J Cardiothorac Surg. 2008 May;33(5):856-61