Myocardial Protection in Complete AVSD Repair: A Decade of Comparative Outcomes Between Custodiol-HTK and Blood Cardioplegia

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2025-09-11 DOI:10.1155/jocs/1280973

Mustafa Kemal Avşar, Yasin Güzel, İbrahim Özgür Önsel, Barış Kırat, İlker Kemal Yücel, Cenap Zeybek, Deniz Yorgancılar

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引用次数: 0

Abstract

Objective: This study compared early postoperative outcomes of Custodiol-HTK versus cold intermittent blood cardioplegia in patients undergoing complete atrioventricular septal defect (CAVSD) repair.

Methods: From January 2012 to December 2022, we retrospectively analyzed 305 patients undergoing CAVSD repair at our center. Patients were divided into two groups based on cardioplegia: Group 1 received Custodiol-HTK (n = 159), and Group 2 received cold intermittent blood cardioplegia (n = 146). Outcomes that were compared included mortality, ECMO requirement, cross-clamp and cardiopulmonary bypass (CPB) times, cardioplegia doses, valvular edema (assessed intraoperatively via a visual scale), postoperative intubation time, ICU stay, and hospital stay.

Results: Mortality was 1.9% in Group 1 versus 8.2% in Group 2 (p = 0.01). ECMO was required in 0.6% of Group 1 versus 11.0% of Group 2 (p < 0.001). Cross-clamp time (56 ± 12 min vs. 76 ± 16 min, p < 0.001) and CPB time (83 ± 14 min vs. 97 ± 17 min, p = 0.002) were shorter in Group 1. Cardioplegia doses were 1 in Group 1 versus 4.7 ± 1.2 in Group 2 (p < 0.001). Intubation time, ICU stay, and hospital stay were significantly shorter in Group 1 (p < 0.01 for each).

Conclusion: Custodiol-HTK was associated with improved early outcomes, including reduced mortality, ECMO use, and shorter operative and recovery times, in CAVSD repair. It appears to offer superior myocardial protection, particularly in complex cases, though potential risks such as hyponatremia require careful perioperative management.

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心肌保护在AVSD完全修复：十年来库斯托尔- htk和血停搏的比较结果

目的：本研究比较cusdiol - htk与冷间歇血停搏对完全性房室间隔缺损（CAVSD）修复患者术后早期的预后。方法：2012年1月至2022年12月，我们回顾性分析了305例在我中心接受CAVSD修复的患者。根据心脏骤停情况将患者分为两组：1组患者接受Custodiol-HTK治疗（n = 159）， 2组患者接受冷间歇血心脏骤停治疗（n = 146）。比较的结果包括死亡率、ECMO要求、交叉钳夹和体外循环（CPB）次数、心脏截瘫剂量、瓣膜水肿（术中通过目测量表评估）、术后插管时间、ICU住院时间和住院时间。结果：1组死亡率为1.9%，2组为8.2% （p = 0.01）。第一组0.6%的患者需要ECMO，而第二组为11.0% （p < 0.001）。1组交叉钳夹时间（56±12 min比76±16 min， p < 0.001）和CPB时间（83±14 min比97±17 min， p = 0.002）较短。第1组骤停剂量为1，第2组为4.7±1.2 （p < 0.001）。组1插管时间、ICU住院时间、住院时间均显著缩短（p < 0.01）。结论：在CAVSD修复中，Custodiol-HTK与改善早期预后相关，包括降低死亡率、ECMO使用、缩短手术和恢复时间。它似乎提供了优越的心肌保护，特别是在复杂的情况下，尽管潜在的风险，如低钠血症需要谨慎的围手术期管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.