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Outcomes of Infant Cardiac Surgery Using Institutional vs Commercial Cardioplegia Solution: A Comparative Analysis
Sidhant Kalsotra1,2, Jianli Bi1, Mark Galantowicz1,2
1Heart Center, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Del Nido cardioplegia in infant heart surgery showed higher initial troponin I and CK-MB levels. However, no significant differences in clinical outcomes were observed between del Nido and institutional solutions.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Cardioplegia Solutions
Background:
- Infant cardiac surgery requires specialized cardioplegia solutions.
- Assessing myocardial injury markers is crucial for evaluating surgical outcomes.
- Comparing del Nido solution with institutional standards provides valuable clinical insights.
Purpose of the Study:
- To compare postoperative outcomes in infants undergoing cardiac surgery using del Nido cardioplegia versus an institutional cardioplegia solution.
- To evaluate myocardial injury markers, including troponin I, CK-MB, and heart fatty acid-binding protein.
- To assess secondary clinical outcomes such as length of stay and arrhythmias.
Main Methods:
- Eighty-five infants were enrolled, with 45 receiving del Nido and 40 receiving institutional cardioplegia.
- Primary outcomes measured were serum troponin I, CK-MB, and heart fatty acid-binding protein at various postoperative time points.
- Secondary outcomes included vasoactive inotropic score, arrhythmias, ejection fraction, ventilation, CTICU, and hospital stay duration, and mortality.
Main Results:
- The del Nido group had higher initial postoperative troponin I and CK-MB levels compared to the institutional group.
- No significant differences were found in heart fatty acid-binding protein levels between the two groups.
- While not statistically significant, patients receiving del Nido cardioplegia had shorter median hospital and CTICU stays.
Conclusions:
- Del Nido cardioplegia is associated with elevated initial postoperative troponin I and CK-MB levels in pediatric cardiac surgery.
- Despite biochemical marker differences, no significant clinical outcome disparities were identified between del Nido and institutional cardioplegia solutions.
- Further research may clarify the long-term clinical implications of these findings.
Background:
This study assessed postoperative outcomes by using markers of myocardial injury in infants who received del Nido vs institutional cardioplegia solution.
Methods:
Eighty-five infants undergoing cardiac surgery were enrolled (del Nido, n = 45; institutional, n = 40). Primary outcomes included serum troponin I, creatine kinase myocardial band (CK-MB), and heart fatty acid-binding protein on cardiothoracic intensive care unit (CTICU) admission and at 6, 12, and 24 hours postoperatively. Secondary outcomes included vasoactive inotropic score, arrhythmias, ventricular ejection fraction, ventilation hours, CTICU hours, hospital length of stay, and mortality.
Results:
Patients receiving del Nido cardioplegia solution were older (174 days vs 105 days) and had higher body weight (5.95 kg vs 5.05 kg). They received greater cardioplegia volume and had longer bypass times. The del Nido cohort showed higher initial postoperative troponin I (1.53 times at admission; P = .02) and CK-MB levels (1.61 times on admission; P = .01; 1.51 times at 6 hours; P = .03; 1.55 times at 12 hours; P = .02) before normalizing. No differences were found in heart fatty acid-binding protein levels. Median postoperative hospital length of stay (5 days vs 7 days; P = .2) and CTICU stay (45 hours vs 70 hours; P = .077) were shorter for patients receiving the del Nido cardioplegia, although this was not statistically significant. No differences were observed in arrhythmias, ventricular ejection fraction, intubation time, or vasoactive inotropic score. There was no in-hospital or 30-day mortality.
Conclusions:
The del Nido cardioplegia was associated with higher initial postoperative troponin I and CK-MB levels in infant cardiac surgery patients. However, no significant clinical outcome differences were found between the 2 solutions.
