Scavenging right atrial Custodiol-HTK cardioplegia: Impact on hyponatremia and seizures in pediatric cardiac surgery patients

ABSTRACT OBJECTIVE Custodiol-HTK cardioplegia causes fluctuations in serum sodium levels, hyponatremia, and is associated with postoperative seizures. We investigated the impact of scavenging right atrial effluent during delivery on intraoperative serum sodium levels and postoperative seizure incidence in pediatric cardiac surgery patients. METHODS A total of 204 patients less than 18 years old undergoing congenital heart surgery between January 2016 and March 2018 were analysed retrospectively. Serum sodium levels after administration of HTK were compared between the scavenge (Sc) versus non-scavenge (NSc) groups and then in the propensity score-matched cohort (n = 96). Postoperative seizures were documented clinically and with EEG findings. Logistic regression models were used to identify the independent predictors of serum sodium level after aortic cross-clamp. RESULTS Of the 204 patients, 156 (76.5%) were in the NSc, and 48 (23.5%) Sc groups. A serum sodium less than 130 mEq/L after cross clamp and administration of HTK in the NSc group were 70% versus 21% in the Sc group (odds ratio [OR], 8.8; 95% confidence interval [CI], 4.1–18.3; p CONCLUSIONS Right atrial effluent scavenging was protective against fluctuations in serum sodium levels after cross clamp and HTK administration independently in both entire and matched cohort, and was also associated with decreased incidence of postoperative seizures.