Warm Blood Cardioplegia Versus Histidine, Tryptophan, and Ketoglutarate Solution in Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease: A Meta-Analysis

Abbas, Ali A.; Youssef, Hassan M. A.; Al Maidany, Ashraf A. H.; Hikal, Tamer S. F.

doi:10.21608/ejsur.2025.359082.1384

Warm Blood Cardioplegia Versus Histidine, Tryptophan, and Ketoglutarate Solution in Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease: A Meta-Analysis

Document Type : Original Article

Authors

Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

10.21608/ejsur.2025.359082.1384

Abstract

Background: Postoperative outcomes for those undergoing cardiac surgery with extracorporeal circulation are significantly influenced by myocardial protection. Administration of cardioplegic solution is the primary method for protecting the myocardium. Furthermore, myocardial hypothermia and cardiac arrest that follows significantly lower the myocardium’s oxygen consumption by 95%. Consequently, a suitable and efficient cardioplegia technique must be achieved.
Patients and Methods: This review compiled data from randomized controlled trials and retrospective and prospective
observational studies to assess and compare the therapeutic effects of Custodiol solution and warm blood cardioplegia in coronary artery bypass grafting (CABG) for left main coronary artery disease (CAD). The studies included in this metaanalysis all reported on populations that underwent coronary angioplasty (CABG) for patients who have left main CAD.
Results: The overall summary estimates from the common effect model (risk ratio=0.85, 95% CI: 0.74–0.98) suggest a
significant reduction in postoperative inotropic support with Custodiol, while the random effects model (risk ratio=0.94,
95% CI: 0.70–1.26) shows no significant variation. High heterogeneity (I2=74%, P0.01) indicates substantial variability
among the study results.
Conclusion: In comparing Custodiol solution with warm blood cardioplegia for left primary CAD cases undergoing
CABG, our meta-analysis showed mixed results regarding creatine kinase and Tn-I levels, with Custodiol showing
a significant reduction in creatine kinase levels at 4–7h postsurgery. While Custodiol indicated a potential benefit in
reducing postoperative inotropic support, the variability in outcomes and lack of consistency across studies suggest
caution in interpreting its superiority over warm blood cardioplegia. Further randomized controlled trials are warranted to validate these findings and address the limitations of heterogeneity and publication bias observed in the included studies.

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