Custodiol cardioplegia solution compared to cold blood cardioplegia in pediatric cardiac surgery: a single-institution experience.

Objective: Custodiol is an intracellular, crystalloid cardioplegia solution that is a single-dose alternative to multi-dose cold blood cardioplegia; however, there is scarce data regarding its use in infants and children. The objective of this study was to compare its impact on myocardial function in infants. Methods: Single-center retrospective review including 132 patients Results: Patients receiving Custodiol were slightly younger (100 +/- 62 days) and lower weight (4.7 +/- 1.3 kg) compared to 152 +/- 86 days and 5.2 +/- 1.3 kg for blood cardioplegia (p < 0.05). The Society of Thoracic Surgeons/European Association for Cardio-Thoracic Surgery Congenital Heart Surgery score was similar between both groups. Average cardiopulmonary bypass time was similar between both groups (Custodiol 93 +/- 54 minutes vs. blood 81 +/- 44 minutes, p = 0.46) as was aortic cross-clamp time (Custodiol 58 +/- 33 minutes vs. cold blood 53 +/- 33 minutes, p = 0.62). Pre-operative left ventricular ejection fraction was similar for blood 73 +/- 8% versus Custodiol 70 +/- 9%, p = 0.21. There was also no intergroup difference in left ventricular ejection fraction 24 hours post op (blood 64 +/- 9% vs. Custodiol 65 +/- 12%, p = 0.53) or at discharge (blood 66 +/- 10% vs. Custodiol 66 +/- 11%, p = 0.95). The pre-operative right ventricle function by fractional area change was also similar in blood cardioplegia (46 +/- 13%) versus Custodiol (48 +/- 9%, p = 0.38) and showed similar drops in parameters in the two groups 24 hours after surgery and at discharge. Conclusion: Single-dose Custodiol is as safe as blood cardioplegia for myocardial protection in congenital cardiac surgery for the cross-clamp times evaluated in this study. Evaluation at longer cross-clamp times would be helpful to determine if there is a greater benefit to single-dose Custodiol versus more repeated doses of blood cardioplegia for longer cross-clamp times.