Custodiol versus Cold Blood Cardioloplegia in Minimally Invasive Aortic Valve Surgery: A Comparative Study

Ahmed M Abdelazim; Mahmoud M Abdelazeem Mubarak

Ahmed M Abdelazim Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mahmoud M Abdelazeem Mubarak Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

Keywords: Custodiol, Cold Blood Cardioplegia, Myocardial Protection, Aortic Valve Replacement, Cardiopulmonary

Abstract

Background: Myocardial protection is a critical concern during aortic valve replacement. Custodiol cardioplegia and cold blood cardioplegia represent two primary strategies for myocardial preservation. This study sought to compare Custodiol and blood cardioplegia results for myocardial protection in aortic valve replacement.

Methods: This prospective study included 200 patients who were evenly divided into two groups based on the cardioplegia solution used: the Custodiol group (Group A) and the cold blood cardioplegia group (Group B). The study evaluated postoperative mechanical ventilation duration, ICU and overall hospital stay lengths, and echocardiographic findings at three and six months postoperatively.

Results: Compared with Group B, Group A had significantly shorter ventilation times (min-max: 6-9 vs. 9-15 hours), ICU stays (3-3 vs. 4-5 days), and hospital stays (7-9 vs. 10-20 days) (p<0.001 for all). Group A exhibited shorter cardiopulmonary bypass times (179 ± 9 minutes vs. 216 ± 14 minutes, p<0.001) and cross-clamp times (137 ± 8 minutes vs. 176 ± 18 minutes, p<0.001). Postoperative atrial fibrillation was more common in Group A (66% vs. 20%, p<0.001), while ventricular tachycardia and nodal rhythm post-defibrillation were greater in Group B. Mortality was lower in Group A (2% vs. 9%, p=0.03). However, at three and six months postoperatively, echocardiographic findings were significantly different in terms of left atrial diameter and left ventricular end-systolic diameter between Group A and Group B (p<0.001).

Conclusion: Custodiol cardioplegia could be associated with superior postoperative outcomes, including shorter ventilation times, ICU and hospital stays, and lower mortality rates, compared to cold blood cardioplegia in minimally invasive aortic valve replacement surgery.