Custodiol for myocardial protection and preservation: a systematic review

J. James B Edelman, Michael Seco, Ben Dunne, Shannon J Matzelle, Michelle Murphy, Pragnesh Joshi, Tristan D Yan, Michael K Wilson, Paul G Bannon, Michael P Vallely, Jurgen Passage

    Research output: Contribution to journalArticlepeer-review

    Abstract

    INTRODUCTION: Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant.

    METHODS: Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant.

    RESULTS: Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant.

    CONCLUSIONS: Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required.

    Original languageEnglish
    Pages (from-to)717-28
    Number of pages12
    JournalAnnals of Cardiothoracic Surgery
    Volume2
    Issue number6
    DOIs
    Publication statusPublished - Nov 2013

    Keywords

    • Custodiol solution
    • histidine-tryptophan-ketoglutarate solution
    • heart arrest
    • induced
    • cardiac transplantation

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