Mustafa Kemal Avşar, Yasin Güzel, İbrahim Özgür Önsel, Barış Kırat, İlker Kemal Yücel, Cenap Zeybek, Deniz Yorgancılar
{"title":"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","authors":"Mustafa Kemal Avşar, Yasin Güzel, İbrahim Özgür Önsel, Barış Kırat, İlker Kemal Yücel, Cenap Zeybek, Deniz Yorgancılar","doi":"10.1155/jocs/1280973","DOIUrl":null,"url":null,"abstract":"<p><b>Objective:</b> This study compared early postoperative outcomes of Custodiol-HTK versus cold intermittent blood cardioplegia in patients undergoing complete atrioventricular septal defect (CAVSD) repair.</p><p><b>Methods:</b> 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 (<i>n</i> = 159), and Group 2 received cold intermittent blood cardioplegia (<i>n</i> = 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.</p><p><b>Results:</b> Mortality was 1.9% in Group 1 versus 8.2% in Group 2 (<i>p</i> = 0.01). ECMO was required in 0.6% of Group 1 versus 11.0% of Group 2 (<i>p</i> < 0.001). Cross-clamp time (56 ± 12 min vs. 76 ± 16 min, <i>p</i> < 0.001) and CPB time (83 ± 14 min vs. 97 ± 17 min, <i>p</i> = 0.002) were shorter in Group 1. Cardioplegia doses were 1 in Group 1 versus 4.7 ± 1.2 in Group 2 (<i>p</i> < 0.001). Intubation time, ICU stay, and hospital stay were significantly shorter in Group 1 (<i>p</i> < 0.01 for each).</p><p><b>Conclusion:</b> 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.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/1280973","citationCount":"0","resultStr":"{\"title\":\"Myocardial Protection in Complete AVSD Repair: A Decade of Comparative Outcomes Between Custodiol-HTK and Blood Cardioplegia\",\"authors\":\"Mustafa Kemal Avşar, Yasin Güzel, İbrahim Özgür Önsel, Barış Kırat, İlker Kemal Yücel, Cenap Zeybek, Deniz Yorgancılar\",\"doi\":\"10.1155/jocs/1280973\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><b>Objective:</b> This study compared early postoperative outcomes of Custodiol-HTK versus cold intermittent blood cardioplegia in patients undergoing complete atrioventricular septal defect (CAVSD) repair.</p><p><b>Methods:</b> 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 (<i>n</i> = 159), and Group 2 received cold intermittent blood cardioplegia (<i>n</i> = 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.</p><p><b>Results:</b> Mortality was 1.9% in Group 1 versus 8.2% in Group 2 (<i>p</i> = 0.01). ECMO was required in 0.6% of Group 1 versus 11.0% of Group 2 (<i>p</i> < 0.001). Cross-clamp time (56 ± 12 min vs. 76 ± 16 min, <i>p</i> < 0.001) and CPB time (83 ± 14 min vs. 97 ± 17 min, <i>p</i> = 0.002) were shorter in Group 1. Cardioplegia doses were 1 in Group 1 versus 4.7 ± 1.2 in Group 2 (<i>p</i> < 0.001). Intubation time, ICU stay, and hospital stay were significantly shorter in Group 1 (<i>p</i> < 0.01 for each).</p><p><b>Conclusion:</b> 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.</p>\",\"PeriodicalId\":15367,\"journal\":{\"name\":\"Journal of Cardiac Surgery\",\"volume\":\"2025 1\",\"pages\":\"\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/1280973\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiac Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1155/jocs/1280973\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiac Surgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/jocs/1280973","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Myocardial Protection in Complete AVSD Repair: A Decade of Comparative Outcomes Between Custodiol-HTK and Blood Cardioplegia
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.
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.
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