Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
8679170 | Seminars in Thoracic and Cardiovascular Surgery | 2017 | 9 Pages |
Abstract
We conducted a prospective randomized trial to compare del Nido (DN) cardioplegia with conventional cold blood cardioplegia (St Thomas [STH]) in pediatric patients. We randomized 100 pediatric patients aged â¤12 years undergoing elective repair of ventricular septal defects and tetralogy of Fallot to the DN and the STH groups. In the DN group, a 20âmL/kg single dose was administered. In the STH group, a 30âmL/kg dose was administered, followed by repeated doses at 25- to 30-minute intervals. The primary outcome was cardiac index that was measured 4 times intra- and postoperatively. Troponin-I, interleukin-6, and tissue necrosis factor-alpha were measured. Myocardial biopsy was obtained to assess electron-microscopic ultrastructural changes. Cardiac indices were significantly higher in the DN group than in the STH group 2 hours after termination of cardiopulmonary bypass (Pâ=â0.0006), after 6 hours (Pâ=â0.0006), and after 24 hours (Pââ¤â0.0001). On repeated measure regression analysis, the cardiac index was on an average 0.50 L/min/m2 higher in the DN group than in the STH group at any time point (Pâ=â0.002). Duration of mechanical ventilation (Pâ=â0.01), intensive care unit stay (Pâ=â0.01), and hospital stay (Pâ=â0.0007) was significantly lower in the DN group. Patients in the DN group exhibited lower troponin-I release 24 hours following cardiopulmonary bypass (Pâ=â0.021). Electron microscopic studies showed more myofibrillar disarray in the STH group (Pâ=â0.02). Use of long-acting DN cardioplegia solution was associated with better preservation of cardiac index, lesser troponin-I release, and decreased morbidity. Ultrastructural changes showed better preservation of myofibrillar architecture.
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Authors
Sachin MCh, Amolkumar MCh, Vishnubhatla PhD, Neeti MD, Sudheer MD, Shiv Kumar MCh, Balram MCh,