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Myocardial Protection Efficacy of Custodiol, Del Nido, and Cold Intermittent Blood Cardioplegia in Arterial Switch Operation

Year: 2025

Type: article

Abstract: OBJECTIVES: The arterial switch operation (ASO) is the standard treatment for transposition of the great arteries (TGA), requiring robust myocardial protection due to the neonatal myocardium's vulnerability to ischaemia. This study compares the myocardial protective efficacy of Custodiol, Del Nido, and cold intermittent blood cardioplegia in neonates undergoing ASO. METHODS: We retrospectively analysed 133 neonates with TGA undergoing ASO (2013-2024) at 4 Turkish centres, grouped by cardioplegia: cold blood (n = 47), Custodiol (n = 44), or Del Nido (n = 42). Outcomes included aortic cross-clamp and cardiopulmonary bypass times, troponin I, CK-MB, inotropic support, and ventilation duration. RESULTS: Custodiol and Del Nido had shorter cross-clamp (70.4 (8.5) vs 68.7 (7.9) vs 78.2 (9.1) minutes, P < .001) and bypass times (P = .004), lower troponin I (4.2 (1.3) vs 4.0 (1.5) vs 6.8 (1.9) ng/mL, P < .001), reduced inotropic needs (P < .001), and shorter ventilation/intensive care unit stays (P ≤ .010). Mortality was similar (P = .47). CONCLUSIONS: Custodiol and Del Nido cardioplegia strategies provided favourable outcomes compared to cold blood cardioplegia in neonates undergoing ASO, with implications for optimizing myocardial protection protocols in this population.

Source: Interdisciplinary CardioVascular and Thoracic Surgery

DOI: 10.1093/icvts/ivaf215

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