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Effect of esmolol on myocardial protection in pediatrics congenital heart defects
Saeed Fazelifar1, Hamid Bigdelian1
1Department of Cardiology, Section of Cardiac Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Adding esmolol to cardioplegia in pediatric cardiac surgery reduced inotropic needs and heart damage. This approach may improve cardiac output and conduction system stability post-operation.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Pharmacology
Background:
- Cardioplegia is standard for myocardial protection during cardiac surgery, but optimal types remain debated.
- Limited and conflicting research exists on pediatric cardioplegia, especially regarding beta-blockers.
- Esmolol, an ultrashort-acting beta-blocker, is investigated for its potential to mitigate myocardial ischemia-reperfusion injury.
Purpose of the Study:
- To evaluate the impact of adding esmolol to cardioplegia on myocardial protection in pediatric patients.
- To compare clinical outcomes between pediatric patients receiving cardioplegia with and without esmolol.
Main Methods:
- A comparative study involving pediatric patients undergoing cardiac surgery.
- Patients were divided into two groups: cardioplegia without esmolol (n=35) and cardioplegia with esmolol (n=30).
- Key hemodynamic parameters including left ventricle ejection fraction (LVEF), blood pressure, and central venous pressure (CVP) were monitored.
Main Results:
- The group receiving esmolol had a lower requirement for inotropic support post-operation (86.7% vs. 100%).
- Creatinine kinase-MB (CKMB) levels were significantly lower during surgery in the esmolol group, indicating reduced myocardial damage.
- No significant differences were observed in postoperative arrhythmias, cardiopulmonary bypass duration, extubation time, or ICU stay.
Conclusions:
- Cardioplegia combined with esmolol resulted in reduced inotropic needs and improved cardiac output and ejection fraction one week post-surgery.
- The addition of esmolol appears to reduce intraoperative cardiac damage.
- Patients receiving esmolol may experience enhanced cardiac conduction system stability.
Background:
Although it is accepted that inducing cardioplegia is the gold standard in myocardial protection, there is still no consensus on the exact type of the cardioplegia. There are fewer studies on the type of the cardioplegia in hearts of the children than adults and they are contradictory. The effects of esmolol have been reviewed (a type of ultrashort-acting beta-adrenergic antagonist, i.e., ß-blockers) in conjunction with the cardioplegia due to the effect of the β-blockers in reducing the myocardial ischemia and reperfusion.
Materials And Methods:
The left ventricle ejection fraction (LVEF), systolic blood pressure, central venous pressure (CVP), heart rate, etc., were recorded separately in patients who received the cardioplegia without esmolol (n = 35) and with esmolol (n = 30) and matched for the age and sex.
Results:
The amount of inotrope used in the group without esmolol (100%) was considerably higher than in the group with esmolol (86.7%). Postoperative arrhythmias did not differ significantly between the two groups. There was no significant difference in the duration of cardiopulmonary bypass (CPB), time of the extubation, length of the ICU stay, the first day EF after surgery, and the first week EF after surgery as well. Creatinine kinase-MB (CKMB) was significantly higher in the group without esmolol during operation than in the group with esmolol.
Conclusions:
The patients who received cardioplegia along with esmolol had less inotropic requirement after operation, and increase in EF and cardiac output (CO) 1 week after surgery. In addition, it reduced damage to the heart during surgery, and patients may have greater stability in the cardiac conduction system.
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