Custodial Cardioplegia and Cardiac Preservation during pediatric Cardiac Surgery Procedures: A Narrative Review

Controlled intraoperative cardioplegia is indispensable to pediatric cardiac surgery procedures. Several preservation techniques have been proposed for such purposes, with varying application by different surgeons. The custodiol cardioplegia is a recent approach that is considered to be a safe and effective cardiac protector. This narrative review was conducted via searching in four databases, including PubMed, Scopus, Embase, and ScienceDirect. The studies focused on the efficacy and safety of custodiol cardioplegia reviewed, especially in pediatric cardiac surgeries and relevant procedures. In total, 21 articles were eligible, and the findings highlighted the controversies regarding the use of various cardioplegic solutions and the variability of their application by surgeons. However, data were inadequate regarding the optimal cardioplegic solutions in this regard. Some of the studies performed on adults suggested that custodiol cardioplegia may be equivalent to conventional blood cardioplegia. Most of the reviewed articles showed a consensus on the safety and efficacy of custodiol cardioplegia in adult and pediatric cardiac surgeries. It is believed that custodiol procedures are not only easily delivered, but they are also convenient and less time-consuming and provide long-lasting motion and bloodless fields for the surgeon to perform the operation. Therefore, use of custodiol cardioplegia has been reported to be safe, effective, and cost-efficient compared to conventional cardioplegic solutions. However, different findings have also been denoted in some of the studies in this regard, implying the equal effectiveness of these techniques.