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Comparison of single versus multidose blood cardioplegia in arterial switch procedures
S Y DeLeon1, F S Idriss, M N Ilbawi
1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614.
Insights
Multidose cardioplegia in arterial switch procedures for transposition of the great arteries was associated with longer cross-clamp times and higher early mortality compared to single-dose cardioplegia.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- Transposition of the great arteries (TGA) and Taussig-Bing anomaly are complex congenital heart defects.
- Arterial switch procedure is a standard surgical repair for TGA.
Purpose of the Study:
- To compare the outcomes of multidose versus single-dose cardioplegia during arterial switch procedures for TGA.
- To evaluate the impact of different cardioplegia strategies on surgical times and early mortality.
Main Methods:
- Fifty-three patients with TGA and Taussig-Bing anomaly were divided into two groups.
- Group 1 received multidose cardioplegia (aortic root and coronary ostia).
- Group 2 received single-dose cardioplegia (aortic root only).
Main Results:
- Multidose cardioplegia (Group 1) was associated with significantly longer aortic cross-clamp and bypass times in simple and complex TGA repairs.
- Early mortality was 16% in Group 1, with no early deaths in Group 2.
- No significant differences in cross-clamp or bypass times were observed in staged repairs for simple TGA.
Conclusions:
- Single-dose aortic root cardioplegia appears to be a safer and more efficient strategy for arterial switch procedures in TGA.
- Further research is warranted to optimize cardioplegia delivery in complex congenital heart surgery.
Abstract:
Fifty-three patients with transposition of the great arteries and Taussig-Bing anomaly undergoing an arterial switch procedure were divided into two groups. Group 1 (N = 32) received multidose cardioplegia injected initially into the aortic root and subsequently into the coronary artery orifices and Group 2 (N = 21), single-dose cardioplegia injected into the aortic root. The mean aortic cross-clamp and bypass times were generally longer in Group 1 compared with Group 2. Group 1 patients with simple transposition undergoing primary repair (N = 15) had an aortic cross-clamp time of 80 +/- 8 minutes and a bypass time of 203 +/- 27 minutes versus 64 +/- 6 minutes (p less than 0.001) and 170 +/- 15 minutes (p less than 0.01), respectively, for similar patients in Group 2 (N = 10). Group 1 patients with simple transposition undergoing staged repair (N = 7) had an aortic cross-clamp time of 71 +/- 6 minutes and a bypass time of 201 +/- 24 minutes versus 66 +/- 4 minutes (p = not significant [NS]) and 226 +/- 25 minutes (p = NS), respectively, for Group 2 (N = 6). In Group 1 patients with complex transposition (N = 10), the aortic bypass time was 79 +/- 12 minutes and the bypass time was 261 +/- 40 minutes versus 64 +/- 11 minutes (p less than 0.05) and 225 +/- 16 minutes (p less than 0.1), respectively, for Group 2 (N = 5). Early mortality was 16% (5/32) in Group 1; there were no early deaths in Group 2.(ABSTRACT TRUNCATED AT 250 WORDS)