Background: Myocardial protection for longer aortic cross clamping periods is usually ensured
with cardioplegia. The purpose of this retrospective study was to evaluate the feasibility
and safety of tepid modified full blood cardioplegia (MBC) adapted to pediatric metabolism
for surgical repair of simple septal defects compared with a standard cold crystalloid
cardioplegia (CCC/Custodiol).
Methods: Observational clinical, hemodynamic and laboratory data of 64 retrospectively enrolled
patients with simple septal defects (ASD, n = 34, VSD, n = 32) were matched according to diagnosis and body surface area. MBC (Calafiore cardioplegia
enriched with electrolytes) was applied for 2 minutes and repeated every 20 minutes.
CCC was given as a single shot and repeated every 60 minutes in longer clamping periods.
Intraoperative hemodynamic evaluation of cardiac output and cardiac index was performed
by aortic flow measurement before aortic cross clamping (T1), after bypass (T2) and
after modified ultrafiltration (T3). Measurement of standard cardiac markers included
Troponin-T (TnT) and CKMB at T1, T3 and first postoperative day (T4).
Results: Patient pairs did not statistically differ in aortic cross clamping time and bypass
time. There was no operative mortality. At given observation points cardiac index
and cardiac markers did not differ between groups.
Table 1
|
MBC
|
CCC
|
p-Value
|
|
T1
|
Trop T (ng/mL)
|
0.013 (0.01–0.05)
|
0.021 (0.01–0.11)
|
0.142
|
|
CKMB (μg/L)
|
3.5 (1.9–13.0)
|
5.2 (1.9–13.0)
|
0.952
|
|
CI (L/min/m2)
|
2.8 (1.39–4.15)
|
2.6 (1.44–2.53)
|
0.279
|
|
T2
|
CI (L/min/m2)
|
3.4 (1.77–5.39)
|
2.9 (1.23–5.19)
|
0.949
|
|
T3
|
Trop T (ng/ mL)
|
3.2 (0.34–18)
|
4.2 (0.03–25)
|
0.152
|
|
CKMB (μg/L)
|
144.6 (31–415)
|
167.9 (8.7–455)
|
0.642
|
|
CI (L/min/m2)
|
3.4 (1.62–5.4)
|
3.3 (1.84–5.58)
|
0.854
|
|
T4
|
Trop T (ng/ mL)
|
0.9 (0.25–2.8)
|
1.23 (0.27–3.0)
|
0.172
|
|
CKMB (μg/L)
|
51.5 (5–100)
|
62.2 (28–140)
|
0.751
|
Conclusion: This study indicates that tepid MBC preserves myocardial function as good as CCC
during aortic cross-clamping in the context of corrective pediatric heart surgery
for simple septal defects. Further studies are needed to evaluate possible beneficial
effects of modified pediatric blood cardioplegia for larger patient groups.
