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Cardioplegic protection of the child's heart
Insights
Cardioplegia offers no mortality advantage for pediatric cardiac surgery compared to reperfusion, and prolonged use increases mortality risk. Myocardial damage often occurs despite cardioplegia, contributing to hospital deaths.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Myocardial Preservation
Background:
- Cardioplegia is a standard method for preserving heart muscle during pediatric cardiac surgery.
- Its effectiveness and limitations compared to other methods require ongoing investigation.
Purpose of the Study:
- To investigate the advantages and limitations of cardioplegia for myocardial preservation in pediatric cardiac surgery.
- To compare cardioplegia with reperfusion strategies regarding early mortality and ischemic time.
Main Methods:
- Comparative analysis of early mortality in two patient series (n=200 each).
- One group received reperfusion between aortic cross-clamping periods; the other received cardioplegia.
- Cytochemical and biophysical assessment of right ventricular biopsy specimens (n=129 pairs) before and after ischemia.
- Logistic analysis to determine factors contributing to hospital mortality.
Main Results:
- No significant difference in overall mortality was observed between cardioplegia and reperfusion groups.
- Longer ischemic times were more frequently accepted with cardioplegia (p < 0.01).
- Mortality increased significantly with cardioplegia beyond 85 minutes of ischemia.
- Myocardial deterioration was common despite cardioplegia, with poor biopsy scores predicting hospital death.
- Logistic analysis indicated inadequate myocardial preservation contributed to approximately 50% of hospital deaths.
Conclusions:
- Cardioplegia does not offer a mortality advantage over reperfusion in this pediatric cardiac surgery cohort.
- Prolonged ischemic times exceeding 85 minutes with cardioplegia are associated with increased mortality.
- Inadequate myocardial preservation, even with cardioplegia, is a significant factor in hospital mortality.
Abstract:
The advantages and limitations of cardioplegia as a mode of myocardial preservation in the pediatric cardiac surgical context are investigated. Review of early mortality related to ischemic time demonstrated no difference in overall mortality in consecutive series each of 200 patients, the first protected by reperfusion between intermittent periods of aortic cross-clamping and the second protected by cardioplegia. There was a tendency to accept longer ischemic time with cardioplegia (p less than 0.01). Mortality with cardioplegia increased sharply beyond 85 minutes of ischemia. Cytochemical and biophysical assessment of 129 pairs of right ventricular biopsy specimens taken before and after ischemia usually demonstrated deterioration of myocardium despite cardioplegia, and poor scores were predictive of hospital death. Use of a logistic analysis suggested that about half the hospital deaths were attributable to inadequate myocardial preservation despite cardioplegia.