Small-volume single shot cardioplegia is safe in neonates and infants undergoing congenital heart surgery

Objective: To proof the safety and performance of a novel hyperosmolar, small-volume single-shot cardioplegia (SSC) compared to Buckberg blood cardioplegia (BC) in neonates and infants undergoing congenital heart surgery.

Methods: 42 neonates and infants undergoing repair of VSD, CAVC and AP-pulmonary window, were prospectively enrolled in this study. The entire procedure (anesthesia, cardiopulmonary bypass, surgery) was following a standardized protocol. SSC was administered in 22 patients; 20 patients received BC cardioplegia. Intra-, peri- and postoperative data were collected retrospectively.

Results: Perioperative mortality was 0%; follow-up is complete with all patients alive. Both groups did not differ significantly (age: p = 0.793; body-weight: p = 0.842; size: p = 0.443). Cardioplegic volume was considerably reduced in the SSC group (1.91 ± 0.62 ml/kg vs. 13.80 ± 10.57 ml/kg; p < 0.0001). Hematocrit was higher after SSC (24.27 ± 2.23 vs. 22.55 ± 2.31; p = 0.018) while potassium values were significantly lower after SSC (3.85 ± 0.51 vs. 4.76 ± 0.93 mmol/litres, p < 0.0001). SSC patients required less catecholamine support one (p = 0.071) and six hours (p = 0.071) postoperatively; after 24 hours, no difference could be observed (p = 0.678). No difference was observed for postoperative troponine T values (p = 0.526); the lactate value six hours postoperatively was lower in the SSC group (p = 0.048). Severe low cardiac output in the early postoperative period did not occur in both groups.

Conclusion: Cardioplexol provides safe and effective cardioprotection with a single shot low-volumen cardioplegia in children undergoing repair of simple congenital cardiac defects requiring limited cross clamping times.