Warm blood cardioplegia safe but does not improve myocardial protection in kids undergoing heart surgery
UK: In pediatric heart surgery, warm blood cardioplegia is a reproducible and safe technique but does not provide superior myocardial protection, says a recent study published in the European Journal of Cardio-Thoracic Surgery.
The study showed that postoperative cardiac troponin T levels did not differ in patients receiving warm versus cold-blooded cardioplegia.
Cardioplegia is a solution administered to the heart during cardiac surgery to temporarily and intentionally arrest the heart for myocardial protection. It is a critical component of cardiopulmonary bypass. The primary goal is to reduce myocardial oxygen demand by creating electrical quiescence and cooling the heart to minimize the ischemic effects of being on bypass.
Intermittent cold blood cardioplegia is frequently used in children, whereas intermittent warm blood cardioplegia is used widely in adults. Serban Stoica from University Hospitals Bristol and Weston NHS Foundation Trust in Bristol, UK, and colleagues aimed to compare biochemical and clinical outcomes with these two methods in a single centre, randomized controlled trial.
The study was conducted to compare the effectiveness of warm (≥34°C) compared to cold (4–6°C) antegrade cardioplegia in pediatric patients. Cardiac troponin T was determined over the first 48 postoperative hours (primary outcome). Teams of intensive care were blinded to group allocation. A comparison was made between effects by intention-to-treat using logistic, linear mixed-effects, or Cox regression.
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