P242. Outcomes of Custodiol versus Blood Cardioplegic Agents in Patients Undergoing Major Aortic Surgery: a Propensity Score Matched study
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Barts Heart Centre, St Bartholomew's Hospital
London
United Kingdom - Contact Me
Vinci Naruka graduated from the University of Cambridge (UK) in 2017 and attained the competitive run-through training programme in Cardiothoracic Surgery in London in 2019. During his training he has been rotating and gaining exposure at extremely reputable centres including the Royal Brompton and Harefield hospital, Hammersmith hospital and the Barts Heart Centre in London (UK).
His main areas of interest include minimal invasive cardiac surgery, mitral valve surgery and aortic surgery.
He holds the Residents Committee position for the European Association for Cardio-thoracic surgery (EACTS) where he hopes to widen education in Cardiothoracic Surgery across the Europe.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objectives
Custodiol cardioplegia is well-established in routine and minimally invasive cardiac surgery with the advantage of prolonged myocardial protection with a single infusion without interrupting the operation flow. The aim of this study is to compare the efficacy of Custodiol against blood cardioplegia in patients undergoing major aortic surgery.
Methods
Retrospectively analysed prospectively collated data of patients who underwent major aortic surgery by two experienced aortic surgeons at a large specialist centre in the UK between April 2022 and November 2023.
Patients were 1:1 propensity score matched by age, gender and EuroScoreII (45 Custodiol, 45 blood).
All aortic operations were included, except for isolated aortic valve replacements.
Reported outcomes include operative data, changes in blood and biochemistry results, in-hospital mortality, length of ICU and hospital stay, and adverse postoperative events.
Continuous variables were described as median and Mann-Whitney U test utilised to calculate for statistical significance (p<0.05). Multivariable logistic regression model was employed after adjusting for covariates.
Results
Mean age was 59 years in both cohorts, 71% male (32/45 in each) with a high mean EuroscoreII (7.74% blood and 7.79% Custodiol).
No significant change was noted in pre to postoperative haemoglobin (p=0.14) and sodium (p=0.16) between cardioplegia.
There was no significant difference in postoperative outcomes between the two cohorts including: return to theatre for bleeding (p=0.50), postoperative stroke (p=0.69), new acute kidney injury (p=0.07), pacemaker (p=0.08) or 30-day mortality (2 deaths in Custodiol, 3 in Blood, p=0.65).
Cardiopulmonary bypass and circulatory arrest times were not statistically significant different between blood and custodial cohorts (225 vs 237 minutes, p=0.07; 59.5 and 58 minutes, p=0.42).
Cross-clamp time showed no significant difference between blood and custodial (163 vs 153 minutes, p=0.83). After adjusting for Euroscore II, urgency, redo surgery and operation type, a multivariable regression model reported no significant difference in cross clamp time (p=0.98). However for redo operation, it was associated with an average 44.3 minutes longer cross clamp time which was significant (p=0.002).
Sub-analysis of cross-clamp time between different operation types showed: 36 minutes significantly shorter for root replacement in Custodiol (147.5 vs 183.5 minutes, p=0.005); 16.5 minutes shorter for ascending and hemiarch in Custodiol (146.5 vs 163 minutes, p=0.28) but it did not reach statistical significance. Majority of patients who had arch repair via Custodial were redo operations compared to blood cohort so unable to draw a conclusion.
After adjusting for covariates, there was no statistically significant difference in duration of surgery (p=0.98), mechanical ventilation (p=0.28), ICU stay (p=0.68), and hospital stay (p=0.81).
Conclusions
Custodiol cardioplegic solution is a safe and effective myocardial protective agent compared to traditional blood cardioplegia in patients undergoing major aortic surgery.
The reduced cross-clamp time was most significantly noticeable in patients receiving Custodiol during aortic root replacements without affecting postoperative outcomes.
Authors
Vinci Naruka (1), Samuel Burton (1), Selina Tsai (1), Danielle Blackie (1), Ana Lopez-Marco (1), Benjamin Adams (1), Aung Oo (1)
Institutions
(1) Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London (UK)
Custodiol cardioplegia is well-established in routine and minimally invasive cardiac surgery with the advantage of prolonged myocardial protection with a single infusion without interrupting the operation flow. The aim of this study is to compare the efficacy of Custodiol against blood cardioplegia in patients undergoing major aortic surgery.
Methods
Retrospectively analysed prospectively collated data of patients who underwent major aortic surgery by two experienced aortic surgeons at a large specialist centre in the UK between April 2022 and November 2023.
Patients were 1:1 propensity score matched by age, gender and EuroScoreII (45 Custodiol, 45 blood).
All aortic operations were included, except for isolated aortic valve replacements.
Reported outcomes include operative data, changes in blood and biochemistry results, in-hospital mortality, length of ICU and hospital stay, and adverse postoperative events.
Continuous variables were described as median and Mann-Whitney U test utilised to calculate for statistical significance (p<0.05). Multivariable logistic regression model was employed after adjusting for covariates.
Results
Mean age was 59 years in both cohorts, 71% male (32/45 in each) with a high mean EuroscoreII (7.74% blood and 7.79% Custodiol).
No significant change was noted in pre to postoperative haemoglobin (p=0.14) and sodium (p=0.16) between cardioplegia.
There was no significant difference in postoperative outcomes between the two cohorts including: return to theatre for bleeding (p=0.50), postoperative stroke (p=0.69), new acute kidney injury (p=0.07), pacemaker (p=0.08) or 30-day mortality (2 deaths in Custodiol, 3 in Blood, p=0.65).
Cardiopulmonary bypass and circulatory arrest times were not statistically significant different between blood and custodial cohorts (225 vs 237 minutes, p=0.07; 59.5 and 58 minutes, p=0.42).
Cross-clamp time showed no significant difference between blood and custodial (163 vs 153 minutes, p=0.83). After adjusting for Euroscore II, urgency, redo surgery and operation type, a multivariable regression model reported no significant difference in cross clamp time (p=0.98). However for redo operation, it was associated with an average 44.3 minutes longer cross clamp time which was significant (p=0.002).
Sub-analysis of cross-clamp time between different operation types showed: 36 minutes significantly shorter for root replacement in Custodiol (147.5 vs 183.5 minutes, p=0.005); 16.5 minutes shorter for ascending and hemiarch in Custodiol (146.5 vs 163 minutes, p=0.28) but it did not reach statistical significance. Majority of patients who had arch repair via Custodial were redo operations compared to blood cohort so unable to draw a conclusion.
After adjusting for covariates, there was no statistically significant difference in duration of surgery (p=0.98), mechanical ventilation (p=0.28), ICU stay (p=0.68), and hospital stay (p=0.81).
Conclusions
Custodiol cardioplegic solution is a safe and effective myocardial protective agent compared to traditional blood cardioplegia in patients undergoing major aortic surgery.
The reduced cross-clamp time was most significantly noticeable in patients receiving Custodiol during aortic root replacements without affecting postoperative outcomes.
Authors
Vinci Naruka (1), Samuel Burton (1), Selina Tsai (1), Danielle Blackie (1), Ana Lopez-Marco (1), Benjamin Adams (1), Aung Oo (1)
Institutions
(1) Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London (UK)
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.