Cold Histidine-Tryptophan-Ketoglutarate Solution and Repeated Oxygenated Warm Blood Cardioplegia in Neonates With Arterial Switch Operation

Background The present study aimed to compare myocardial protection, as assessed by cardiac troponin-I release, and short-term outcomes between two groups of neonates undergoing the arterial switch operation (ASO) with either Custodiol cardioplegia (Custodiol HTK, Köhler Chemie GmbH, Bensheim, Germany) or repeated oxygenated warm blood cardioplegia. Methods A total of 218 neonates were enrolled retrospectively from February 2007 through February 2011. All analyses were stratified on the type of procedure (ASO ± ventricular septal defect closure ± aortic arch repair). Troponin concentrations within the first week of surgery were analyzed using mixed models for repeated measurements. To counteract the confounding effect of the coronary anatomy, a sensitivity analysis was conducted after 1:1 matching. Results Overall 30 patients had Custodiol cardioplegia, and 188 had warm blood cardioplegia. High-risk coronary anatomy (single right coronary artery giving rise to the left, intramural course) was associated with higher troponin concentrations and a higher 30-day mortality rate postoperatively, and was more prevalent in the Custodiol group when compared with the warm blood cardioplegia group. Postoperative troponin concentrations were higher in the Custodiol group both before ( p < 0.001) and after matching on the coronary anatomy ( p = 0.03). The 30-day mortality rate was higher in the Custodiol group, 10% versus 1.1% ( p = 0.009), but only a nonsignificant trend was noted after matching. Conclusions The use of Custodiol cardioplegia in neonates undergoing ASO was associated with a larger troponin release when compared with warm blood cardioplegia, suggesting poor myocardial protection. The difference noted in 30-day mortality was not due to the use of Custodiol.