Clinical Outcomes of the Use of Custodiol versus Warm Blood Cardioplegia during Coronary Artery Bypass Grafting in Patients with Significant Left Main Coronary Artery Disease

Ahmed  Sobhy Emara; Yousry  Elsaid Rezk; Ibrahim  Mohammed Reda Kasab; Basem  Mofreh Aglan; Ahmed Elsayed Ahmed Elkafoury; Abdelhamid  Fathi Sherif

Ahmed Sobhy Emara Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Yousry Elsaid Rezk Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Ibrahim Mohammed Reda Kasab Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Basem Mofreh Aglan Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Ahmed Elsayed Ahmed Elkafoury Department of Cardiothoracic Surgery, Mahalla Cardiac Center, El Mahalla El Kobra, Egypt
Abdelhamid Fathi Sherif Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

Keywords: Coronary Artery Bypass Grafting, Custodiol, Warm Blood Cardioplegia, Myocardial Protection, Left Main Coronary Artery Disease

Abstract

Background: Patients who undergo coronary artery bypass graft (CABG) surgery, particularly those with significant left main coronary artery disease (LMCAD), require optimal myocardial protection. The selection between Custodiol and warm blood cardioplegia remains critical in enhancing surgical outcomes and improving postoperative quality of life. This study sought to compare Custodiol and warm blood cardioplegia regarding myocardial protection during CABG surgery.

Methods: This randomized controlled clinical trial was carried out on 100 patients with significant LMCAD. Patients underwent CABG surgery using either Custodiol (Group I, n= 50) or intermittent antegrade warm blood cardioplegia (Group II, n= 50). In Group I, 13 patients were female (26%); in Group II, 15 were female (30%).

Results: Both groups had comparable preoperative demographics. Use of hemofilter [8 (16%) vs. 1 (2%), p= 0.004], DC shock [ 6 (12%) vs. 1 (2%), p= 0.037] were more common in Group I. Arrhythmia occurred more frequently in Group I intraoperatively [ 9 (18%) vs. 2 (4%), p= 0.009]. No early mortality was observed in either group. Postoperative data revealed no significant differences between the groups in vital parameters, complications, echocardiographic data, or mortality.

Conclusion: Both Custodiol and warm blood cardioplegia demonstrated comparable efficacy and safety profiles for myocardial preservation during CABG surgery in patients with significant LMCAD. Custodiol could be an effective alternative to blood cardioplegia in patients with LMCAD.