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Ann Thorac Surg 2005;80:989-994
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Blood Cardioplegia Provides Superior Protection in Infant Cardiac Surgery

^a Department of Pediatric Cardiology and Pediatric Anesthesia and Intensive Care, The Queen Silvia Children’s Hospital, Göteborg, Sweden
^b Department of Thoracic and Cardiovascular Surgery, Sahlgrenska University Hospital , Göteborg, Sweden

Accepted for publication March 23, 2005.

^_* Address reprint requests to Dr Åmark, Department of Pediatric Cardiology, The Queen Silvia Children’s Hospital, SE-416 85 Göteborg, Sweden (Email: kerstin.amark{at}vgregion.se).

BACKGROUND: We hypothesized that blood cardioplegia preserves myocardial metabolism and function more effectively than St Thomas’ crystalloid cardioplegia in infant cardiac surgery.

METHODS: Thirty infants with atrioventricular septal defects were randomly allocated to either blood or crystalloid intermittent cold (4°C) cardioplegia. Arterial and coronary sinus blood was analyzed for lactate and oxygen. Cardiac output (thermodilution) and left ventricular function (echocardiography) were evaluated.

RESULTS: The lactate concentration in coronary sinus blood early after bypass was significantly higher after crystalloid cardioplegia than after blood cardioplegia (2.1 ± 0.3 vs 1.3 ± 0.1 mmol/L, p = 0.006), with a significant myocardial release of lactate after crystalloid but not after blood cardioplegia. Oxygen extraction (arterial–coronary sinus O₂ content) was higher early after crystalloid cardioplegia (3.02 ± 0.13 vs 2.35 ± 0.22 mmol/L, p = 0.01), possibly reflecting a difference in oxygen debt. The cardiac index was higher after blood cardioplegia (4.9 ± 0.3 vs 4.0 ± 0.3 L/min^–1/m^–2, p = 0.04) and echocardiographic grading of left ventricular function was better (4.1 ± 0.17 vs 3.5 ± 0.22 arbitrary units, p = 0.046).

CONCLUSIONS: This study indicates that blood cardioplegia preserves myocardial metabolism and function more effectively than crystalloid cardioplegia in infant cardiac surgery. The clinical significance of this finding is uncertain, but the more than 20% increase in cardiac index in the critical phase during weaning from bypass may be advantageous.

This article has been cited by other articles:

				S. G. Raja Is blood cardioplegia superior to crystalloid cardioplegia in pediatric cardiac surgery? Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 498 - 499. [Full Text] [PDF]

				K. Amark, H. Berggren, K. Bjork, A. Ekroth, R. Ekroth, K. Nilsson, and J. Sunnegardh Myocardial metabolism is better preserved after blood cardioplegia in infants. Ann. Thorac. Surg., July 1, 2006; 82(1): 172 - 178. [Abstract] [Full Text] [PDF]

				H. J. Geissler and U. Mehlhorn Cold crystalloid cardioplegia MMCTS, January 9, 2006; 2006(0109): 1040. [Abstract] [Full Text] [PDF]