I use this kind of cardioplegia that is really fantastic. In pediatric cardiac surgery it gives you the opportunity to adiminster a single dose that is efficient up to 3 hours. I usually remove it by suction because in my operation we usually have bicaval cannulation and open right atrium

In our institution (adult cardiac surgery) we usually perform antegrade cardioplegia with Custodiol cardioplegic solution. We prevent excessive hemodilution and the consequent hyponatriemia by directely suctioning the plegic solution in the right atrium with the waste aspirator. If the return of solution in the right atrium is highly mixed with blood we aspirate it with the cell saver aspirator. In those cases in which despite the aforementioned measures hemodilution and hyponatriemia occur we use diuretics or alternatively we perform hemofiltration during CPB.

I have never done research about it, My comment based on my experience(Empiria based medicine), in children we sucked it also into the waste part. In adults, I usually give it below 125 mmol/l actual Natrium level, cca 1 mmol/kg. Check the preop natrium/sodium level, and do not go above +10 mmol/l sodium level compared the baseline we had one pontine myelolysis during 25 years. BW Andrea

We use 3 types of cardioplgia for myocardial preservation (crystalloid, blood 4:1 and custodiol). Now we are trying to introduce del nido cardioplegia for adults and pediatrics. Before we gave a calculated dose of hypertonic sodium, diuretics  and hemofiltration. Now on, hyponatrimia and hemodilution treated by suctionning, diuretics, hemofiltration and sodium bicarbonate to correct acidosis ending with acceptable level of sodium.

We are trying to introduce Custodiol cardioplegia as a method for  myocardial protection specifically aiming at our minimally invasive mitral surgery cases. I have found this answer for hyponatremia related with custodiol during CPB:

A note from the perfusionist: 

"CUSTODIOL® HTK is a hyper-polarizing cardioplegia and because of the large histidine buffer concentration, there is no room, osmolality wise, for normal Na+ levels. This is why the Na+ drops. It does not cause harm to the patient, and can be easily fixed with DUF (dilutional ultrafiltration with NaHCO3 buffered 0.9% NCL soultion).”

We use a "high performance hemoconcentrator

like MiinnTech   Hemocor HPH 1400  or Sorin SH14.  To correct

the Na+,  we ZBUF with 0.9% Saline buffered with 25 Meq of NaHcO3 per

liter.

Who  use Custodiol cardioplegia in heart transplantation? Any experience with long preservation times? More then 4 hours? And any problemi with hypersodiemic donors? More than 160mg/dl? We had some problem recently. Anyone else?

according to study from 2011 is the hyponatremia after Custodiol  a risk factor  for seizures in children.  We use it  for heartport surgery an try to correct with hypertonic Na, diuretics. ultrafiltration.