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Warm continuous antegrade blood cardioplegia: applications in congenital heart disease
A Elami1, E Milgalter, G Merin
1Department of Cardiothoracic Surgery, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Insights
Continuous warm blood cardioplegia is a safe and effective method for myocardial protection during intracardiac procedures. This technique, including its use in total cavopulmonary connection, demonstrates excellent patient recovery and minimal complications.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
- Myocardial Protection
Background:
- Continuous warm blood cardioplegia is a common technique for myocardial protection in acquired heart disease surgery.
- Its application in intracardiac procedures via the right atrium, particularly for total cavopulmonary connection, requires evaluation.
Purpose of the Study:
- To assess the feasibility and safety of continuous warm blood cardioplegia for intracardiac repairs.
- To specifically evaluate this method in total cavopulmonary connection procedures.
Main Methods:
- The study included 23 atrial septal defect closures, 2 atrial septectomies, and 4 total cavopulmonary connections.
- Antegrade blood cardioplegia was delivered continuously (avg. 27 min) at 130 cc/min to maintain aortic root pressure (60-80 mmHg).
- De-airing was performed on a beating heart before aortic cross-clamp removal.
Main Results:
- All patients achieved sinus rhythm postoperatively.
- Most patients exhibited normal cardiac output; one required revision of the cavopulmonary connection due to pulmonary vascular resistance.
- No neurological complications were observed in any patient.
Conclusions:
- Normothermic aerobic arrest using continuous warm blood cardioplegia is safe for congenital heart defect repair.
- This method may offer superior myocardial protection for complex surgeries like the Fontan procedure.
Unlabelled:
Continuous warm blood cardioplegia is utilized by many surgeons as their method of choice for myocardial protection during operations for acquired heart disease.
Objective:
this study was performed to determine the feasibility and safety of this method for intracardiac procedures through the right atrium and in particular, total cavopulmonary connection.
Materials And Methods:
procedures included closure of an atrial septal defect (23), atrial septectomy (2) and total cavopulmonary connection (4). Antegrade blood cardioplegia was delivered continuously for an average of 27 +/- 21 minutes at an average flow of 130 +/- 60 cc/min to maintain the aortic root pressure between 60 and 80 mmHg (mean 74 +/- 5 mmHg). Perfusion with regular blood commenced in the last 2 to 8 minutes and complete de-airing procedure was performed on the beating heart before removal of the aortic cross-clamp.
Results:
all patients resumed sinus rhythm and all but one had normal cardiac output postoperatively. In one patient after cavopulmonary connection the inferior vena-cava to pulmonary-artery connection was taken down because of increased pulmonary vascular resistance resulting in low output state. All patients made an uneventful recovery without neurological complications.
Conclusions:
this initial experience suggests that normothermic aerobic arrest can be used safely in the repair of congenital defects and may provide superior myocardial protection for complex procedures such as the Fontan procedure.