Myocardial protection remains one of the most critical determinants of success in cardiac surgery, particularly during prolonged ischemic periods associated with cardiopulmonary bypass and aortic cross-clamping. The article Custodial-HTK Cardioplegia in Conventional Cardiac Surgery: A Retrospective Analysis From UiTM presents an institutional experience evaluating the clinical performance of Custodial-HTK solution compared with traditional blood cardioplegia in a real-world tertiary cardiac surgery setting in Malaysia. 

The study addresses a clinically relevant question: whether Custodial-HTK, a single-dose crystalloid cardioplegia originally developed for organ preservation, can provide myocardial protection comparable to blood cardioplegia in patients undergoing complex or high-risk cardiac procedures. This is especially important for smaller or resource-limited cardiac centers, where prolonged operations and reduced access to advanced mechanical circulatory support systems can increase perioperative risk.

The investigators conducted a retrospective observational cohort study involving 79 elective patients who underwent conventional on-pump, cross-clamp cardiac surgery at Universiti Teknologi MARA (UiTM) between August 2022 and July 2023. Emergency cases, off-pump surgeries, on-pump beating heart procedures, and patients with incomplete records were excluded. Of the included cohort, 10 patients received Custodial-HTK cardioplegia, while 69 received standard blood cardioplegia. The choice of cardioplegia was not randomized but rather determined collaboratively by the surgeon, perfusionist, and anesthesiologist, with Custodial-HTK preferentially selected for patients with impaired left ventricular ejection fraction (LVEF <40%) or those undergoing complex procedures involving multiple concomitant interventions.