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

## TL;DR

This study compares three heart protection methods during a critical heart surgery in newborns, finding that Custodiol and Del Nido offer better outcomes than traditional cold blood cardioplegia.

## Contribution

The study provides new comparative evidence on myocardial protection efficacy in neonates undergoing arterial switch operation.

## Key findings

- Custodiol and Del Nido cardioplegia reduced cross-clamp and bypass times compared to cold blood cardioplegia.
- Custodiol and Del Nido resulted in lower troponin I levels and reduced inotropic support needs.
- Ventilation and ICU stays were shorter with Custodiol and Del Nido compared to cold blood cardioplegia.

## Abstract

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.

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.

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).

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.

Transposition of the great arteries (TGA) is a critical congenital heart defect requiring arterial switch operation (ASO).