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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Intermittent antegrade warm-blood versus cold-blood cardioplegia in children undergoing open heart surgery: a
Rachael Heys1,2, Serban Stoica3, Gianni Angelini2,4
1Bristol Trials Centre, Clincal Trials and Evaulation Unit, Bristol Medical School, University of Bristol, Bristol, UK rh13369@bristol.ac.uk.
Insights
This study compares warm versus cold blood cardioplegia in pediatric heart surgery. It investigates which method better protects the heart during and after cardiopulmonary bypass (CPB) and cardioplegic arrest.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Cardiothoracic Anesthesia
Background:
- Congenital heart defect repair often necessitates cardiopulmonary bypass (CPB) and cardioplegic arrest.
- Myocardial protection during cardiac surgery is crucial to mitigate ischemia-reperfusion injury.
- Current practice varies, with cold cardioplegia prevalent in pediatrics and warm cardioplegia in adults.
Purpose of the Study:
- To compare the clinical and biochemical outcomes of warm versus cold blood cardioplegia in pediatric congenital heart surgery.
- To provide evidence supporting the optimal cardioplegia strategy for myocardial protection in this patient population.
Main Methods:
- A single-center randomized controlled trial involving pediatric patients undergoing cardiac surgery requiring CPB.
- Participants are randomized 1:1 to receive either cold-blood cardioplegia or warm-blood cardioplegia.
- Primary outcome: Troponin T levels in the first 48 postoperative hours; secondary outcomes include cardiac function, renal function, and mortality.
Main Results:
- This is a pre-results abstract; specific findings are not yet available.
- The trial is registered (ISRCTN13467772) and actively recruiting participants.
- Data collection and analysis are ongoing to determine the primary and secondary outcomes.
Conclusions:
- The study aims to determine the superior cardioplegia method for pediatric congenital heart surgery.
- Findings will inform clinical practice regarding myocardial protection strategies.
- Dissemination of results is planned through peer-reviewed publications and conference presentations.
Introduction:
Surgical repair of congenital heart defects often requires the use of cardiopulmonary bypass (CPB) and cardioplegic arrest. Cardioplegia is used during cardiac surgery requiring CPB to keep the heart still and to reduce myocardial damage as a result of ischaemia-reperfusion injury. Cold cardioplegia is the prevalent method of myocardial protection in paediatric patients; however, warm cardioplegia is used as part of usual care throughout the UK in adults. We aim to provide evidence to support the use of warm versus cold blood cardioplegia on clinical and biochemical outcomes during and after paediatric congenital heart surgery.
Methods And Analysis:
We are conducting a single-centre randomised controlled trial in paediatric patients undergoing operations requiring CPB and cardioplegic arrest at the Bristol Royal Hospital for Children. We will randomise participants in a 1:1 ratio to receive either 'cold-blood cardioplegia' or 'warm-blood cardioplegia'. The primary outcome will be the difference between groups with respect to Troponin T levels over the first 48 postoperative hours. Secondary outcomes will include measures of cardiac function; renal function; cerebral function; arrythmias during and postoperative hours; postoperative blood loss in the first 12 hours; vasoactive-inotrope score in the first 48 hours; intubation time; chest and wound infections; time from return from theatre until fit for discharge; length of postoperative hospital stay; all-cause mortality to 3 months postoperative; myocardial injury at the molecular and cellular level.
Ethics And Dissemination:
This trial has been approved by the London - Central Research Ethics Committee. Findings will be disseminated to the academic community through peer-reviewed publications and presentation at national and international meetings. Patients will be informed of the results through patient organisations and newsletters to participants.
Trial Registration Number:
ISRCTN13467772; Pre-results.
