Custodial HTK Cardioplegia in conventional cardiac surgery: A retrospective analysis From UiTM.

INTRODUCTION

Custodial-HTK (Histidine-Tryptophan- Ketoglutarate) solution and blood cardioplegia are both established methods for myocardial protection during cardiac surgery. However, their utility in patients undergoing complex cardiac surgery is not extensively study. This study compares clinical outcomes between patients receiving Custodial-HTK and blood cardioplegia in one of the tertiary Malaysian cardiac center.

MATERIALS AND

METHODS

We retrospectively analyzed data from 79 patients who underwent elective, on-pump, crossclamp cardiac surgeries at Faculty of Medicine, Universiti Teknologi MARA (UiTM) from August 2022 to July 2023. Patients undergoing emergency procedures, off-pump, or incomplete records were excluded. Patients receiving Custodial-HTK were typically those with impaired LVEF or requiring complex surgeries.

RESULTS

Custodial-HTK was used in 12% of cases. These patients had slightly higher mean age (61.9 ± 7.6 vs. 59.9 ± 8.8 years) and higher mean EuroSCORE II, although the latter was not statistically significant (p = 0.115). Comorbidities including diabetes, hypertension, stroke, and renal disease were comparable between groups. The Custodial group showed significantly lower mean LVEF (43.7 ± 14.7%) and greater use of pre-induction intra-aortic balloon pump (IABP) (20%). Complex procedures were more frequent (50%), with longer mean cardiopulmonary bypass (181.7 ± 65.1 minutes) and cross-clamp durations (131.3 ± 50.4 minutes). Despite these differences, postoperative complication rates, ICU stay, total hospital stay, and 30-day mortality did not differ significantly between groups.

CONCLUSION

Although patients receiving Custodial-HTK had higher surgical complexity and poorer baseline cardiac function, postoperative outcomes were within acceptable clinical range to the blood cardioplegia group. These findings support the use of Custodial-HTK as a safe and effective alternative in high-risk cardiac surgery patients.