Custodiol Versus Blood Cardioplegia: Comparison of Myocardial Protection in Adult Cardiac Cases

Persistent Link:
http://hdl.handle.net/10150/311551
Title:
Custodiol Versus Blood Cardioplegia: Comparison of Myocardial Protection in Adult Cardiac Cases
Author:
Boros, Daniella
Issue Date:
2013
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Objectives: When used as a cardioplegic solution, Custodiol® HTK solution is typically administered in a single-dose, allowing the operation to be performed continuously. This is an advantage over alternative cardioplegic solutions that may have to be re-administered every 20-30 minutes. Although Custodiol is widely used as a cardioplegic solution in Europe, its use for myocardial protection remains an off-label indication in the United States. Thus, the aim of this study is to compare the efficacy of Custodiol to standard 4:1 blood cardioplegia in adult cardiac cases. METHODS: This study was a single-center retrospective review of prospectively collected data. Adult cardiac cases performed between November 2011 and August 2013 using Custodiol® were compared to cases using standard Plegisol® 4:1 blood cardioplegia. Twenty-six primary intra-operative and post-operative endpoints were compared including 30-day mortality, 30-day hospital readmission, prolonged mechanical ventilation time, and renal failure. RESULTS: Of the 229 cases identified, 63 cases used Custodiol and 166 used 4:1 blood cardioplegia. Demographics were similar in both groups with a mean patient age of 65.27±15.07 years for Custodiol and 66.72±12.85 years for 4:1 blood cardioplegia. The average cardiopulmonary bypass time for Custodiol and 4:1 blood cardioplegia was 124.76±61.45 and 137.93±54.05 minutes respectively. The Custodiol group had a greater incidence of prolonged ventilation (>24 hours), 20.6% versus 15.1% respectively, and this approached statistical significance with a p value of 0.052. Intra-operative blood usage was significantly higher in the Custodiol group compared to the blood cardioplegia group, with 44.4% of patients receiving fresh frozen plasma during the operation compared to only 25.3% in the blood cardioplegia group (p=0.005). The results revealed no statistically significant difference in 30-day mortality, 30-day hospital readmission, renal failure, and stroke. CONCLUSION: Despite the distinct advantage of long-term ischemic tolerance, Custodiol use was associated with an increased requirement for fresh frozen plasma during the perioperative period when compared to blood cardioplegia.
Type:
text; Electronic Thesis
Keywords:
Custodiol; myocardial protection; Medical Pharmacology; blood cardioplegia
Degree Name:
M.S.
Degree Level:
masters
Degree Program:
Graduate College; Medical Pharmacology
Degree Grantor:
University of Arizona
Advisor:
Larson, Douglas F.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_US
dc.titleCustodiol Versus Blood Cardioplegia: Comparison of Myocardial Protection in Adult Cardiac Casesen_US
dc.creatorBoros, Daniellaen_US
dc.contributor.authorBoros, Daniellaen_US
dc.date.issued2013-
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractObjectives: When used as a cardioplegic solution, Custodiol® HTK solution is typically administered in a single-dose, allowing the operation to be performed continuously. This is an advantage over alternative cardioplegic solutions that may have to be re-administered every 20-30 minutes. Although Custodiol is widely used as a cardioplegic solution in Europe, its use for myocardial protection remains an off-label indication in the United States. Thus, the aim of this study is to compare the efficacy of Custodiol to standard 4:1 blood cardioplegia in adult cardiac cases. METHODS: This study was a single-center retrospective review of prospectively collected data. Adult cardiac cases performed between November 2011 and August 2013 using Custodiol® were compared to cases using standard Plegisol® 4:1 blood cardioplegia. Twenty-six primary intra-operative and post-operative endpoints were compared including 30-day mortality, 30-day hospital readmission, prolonged mechanical ventilation time, and renal failure. RESULTS: Of the 229 cases identified, 63 cases used Custodiol and 166 used 4:1 blood cardioplegia. Demographics were similar in both groups with a mean patient age of 65.27±15.07 years for Custodiol and 66.72±12.85 years for 4:1 blood cardioplegia. The average cardiopulmonary bypass time for Custodiol and 4:1 blood cardioplegia was 124.76±61.45 and 137.93±54.05 minutes respectively. The Custodiol group had a greater incidence of prolonged ventilation (>24 hours), 20.6% versus 15.1% respectively, and this approached statistical significance with a p value of 0.052. Intra-operative blood usage was significantly higher in the Custodiol group compared to the blood cardioplegia group, with 44.4% of patients receiving fresh frozen plasma during the operation compared to only 25.3% in the blood cardioplegia group (p=0.005). The results revealed no statistically significant difference in 30-day mortality, 30-day hospital readmission, renal failure, and stroke. CONCLUSION: Despite the distinct advantage of long-term ischemic tolerance, Custodiol use was associated with an increased requirement for fresh frozen plasma during the perioperative period when compared to blood cardioplegia.en_US
dc.typetexten_US
dc.typeElectronic Thesisen_US
dc.subjectCustodiolen_US
dc.subjectmyocardial protectionen_US
dc.subjectMedical Pharmacologyen_US
dc.subjectblood cardioplegiaen_US
thesis.degree.nameM.S.en_US
thesis.degree.levelmastersen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineMedical Pharmacologyen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorLarson, Douglas F.en_US
dc.contributor.committeememberLarson, Douglas F.en_US
dc.contributor.committeememberFrench, Edwarden_US
dc.contributor.committeememberOssipov, Michaelen_US
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