Cardioplegia practice in paediatric cardiac surgery: a UK &amp; Ireland survey

Drury, Nigel E; Horsburgh, A. G.; Bi, Rehana; Willetts, Robert G.; Jones, Timothy J.

doi:10.1177/0267659118794343

Cited by 10 publications

(13 citation statements)

References 15 publications

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“…The absence of oxygen and metabolic substrates for cardiomyocytes occurring during ischemia can cause functional, structural, and metabolic changes [ 5 ]. During ischemia, myocardial cells switch from aerobic to anaerobic metabolism resulting in the accumulation of lactate and the generation of acidosis, leading to a decrease in intracellular pH, while myocardial contraction is impaired due to alterations in calcium ion homeostasis [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although the restoration of blood (reperfusion) to an ischemic heart is essential in order to save the myocardium, it can paradoxically cause irreversible myocardial damage termed “ischemia–reperfusion (I–R) injury”. Reperfusion after an ischemic episode may result in cardiomyocyte dysfunction caused by the production of reactive oxygen species (ROS), intracellular and mitochondrial Ca 2+ overload, and the accumulation of inflammatory cells [ 5 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, heterogeneity in cardioplegia practices exists in medical institutions worldwide, which certainly affects the clinical outcomes in children. Data suggest that blood cardioplegia is the most commonly used; however, the choice of the type of solution, temperature, and dosing intervals differ among surgeons [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Cardioplegia in Open Heart Surgery: Age Matters

Bradić

Andjić

Jeremić

et al. 2023

JCM

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Introduction: Cardioplegia is a pharmacological approach essential for the protection of the heart from ischemia–reperfusion (I–R) injury. Over the years, numerous cardioplegic solutions have been developed, with each cardioplegic approach having its advantages and disadvantages. Cardioplegic solutions can be divided into crystalloid and blood cardioplegic solutions, and an experienced surgeon chooses the type of solution based on the individual needs of patients in order to provide optimal heart protection. Importantly, the pediatric immature myocardium is structurally, physiologically, and metabolically different from the adult heart, and consequently its needs to achieve cardioplegic arrest strongly differ. Therefore, the present review aimed to provide a summary of the cardioplegic solutions available to pediatric patients with a special focus on emphasizing differences in heart injury after various cardioplegic solutions, the dosing strategies, and regimens. Material and methods: The PubMed database was searched using the terms cardioplegia, I–R, and pediatric population, and studies that investigated the influence of cardioplegic strategies on markers of cardiac muscle damage were further analyzed in this review. Conclusions: A large body of evidence suggested more prominent benefits achieved with blood compared to those with crystalloid cardioplegia in pediatric myocardium preservation. However, standardized and uniform protocols have not been established so far, and an experienced surgeon chooses the type of cardioplegia solution based on the individual needs of patients, while the severity of myocardial damage strongly depends on the type and duration of the surgical procedure, overall patient condition, and presence of comorbidities, etc.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardioplegia in Open Heart Surgery: Age Matters

Bradić

Andjić

Jeremić

et al. 2023

JCM

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“…However, variability in practice suggests the optimum method is unknown. Specifically regarding cardioplegia, North American centres favour the del Nido solution, whereas in the UK, St Thomas’ solution is preferred [ 2 , 3 ]. The physiological evidence for cardioplegic arrest is compelling [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Warm versus cold blood cardioplegia in paediatric congenital heart surgery: a randomized trial

Stoica

Smartt

Heys

et al. 2023

European Journal of Cardio-Thoracic Surgery

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Objectives Intermittent cold blood cardioplegia is commonly used in children whereas intermittent warm blood cardioplegia is widely used in adults. We aimed to compare clinical and biochemical outcomes with these two methods. Methods A single centre, randomized controlled trial was conducted to compare the effectiveness of warm (≥34°C) versus cold (4–6°C) antegrade cardioplegia in children. The primary outcome was cardiac troponin T over the first 48 postoperative hours. Intensive care teams were blinded to group allocation. Outcomes were compared by intention-to-treat using linear mixed-effects, logistic, or Cox regression. Results 97 participants with median age of 1.2 years were randomized (49 to warm, 48 to cold cardioplegia); 59 participants (61%) had a risk-adjusted congenital heart surgery score of 3 or above. There were no deaths and 92 participants were followed to 3-months. Troponin release was similar in both groups (geometric mean ratio 1.07; 95% confidence interval [CI], 0.79–1.44; P = 0.66), as were other cardiac function measures (echocardiography, arterial and venous blood gases, vasoactive-inotrope score, arrhythmias). Intensive care stay was on average 14.6 hours longer in the warm group (hazard ratio 0.52; 95% CI, 0.34–0.79; P = 0.003), with a trend towards longer overall hospital stays (hazard ratio 0.66; 95% CI, 0.43–1.02; P = 0.060) compared with the cold group. This could be related to more unplanned reoperations on bypass in the warm group compared to cold group (3 vs 1). Conclusions Warm blood cardioplegia is a safe and reproducible technique but does not provide superior myocardial protection in paediatric heart surgery. Clinical Trial Registry Number ISRCTN13467772

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“…Hypothermic cardioplegia solution is the prevalent method of myocardial protection in paediatric patients, however, there is wide variation in practice. 5 6 Cold cardioplegia is used to lower myocardial oxygen demands and the risk of IRI. However, intermittent warm-blood cardioplegia (IWBC) is considered to be an effective method of myocardial protection in adults undergoing surgical repair and is used in usual practise in the UK.…”

Section: Introductionmentioning

confidence: 99%

Intermittent antegrade warm-blood versus cold-blood cardioplegia in children undergoing open heart surgery: a protocol for a randomised controlled study (Thermic-3)

et al. 2020

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IntroductionSurgical repair of congenital heart defects often requires the use of cardiopulmonary bypass (CPB) and cardioplegic arrest. Cardioplegia is used during cardiac surgery requiring CPB to keep the heart still and to reduce myocardial damage as a result of ischaemia–reperfusion injury. Cold cardioplegia is the prevalent method of myocardial protection in paediatric patients; however, warm cardioplegia is used as part of usual care throughout the UK in adults. We aim to provide evidence to support the use of warm versus cold blood cardioplegia on clinical and biochemical outcomes during and after paediatric congenital heart surgery.Methods and analysisWe are conducting a single-centre randomised controlled trial in paediatric patients undergoing operations requiring CPB and cardioplegic arrest at the Bristol Royal Hospital for Children. We will randomise participants in a 1:1 ratio to receive either ‘cold-blood cardioplegia’ or ‘warm-blood cardioplegia’. The primary outcome will be the difference between groups with respect to Troponin T levels over the first 48 postoperative hours. Secondary outcomes will include measures of cardiac function; renal function; cerebral function; arrythmias during and postoperative hours; postoperative blood loss in the first 12 hours; vasoactive-inotrope score in the first 48 hours; intubation time; chest and wound infections; time from return from theatre until fit for discharge; length of postoperative hospital stay; all-cause mortality to 3 months postoperative; myocardial injury at the molecular and cellular level.Ethics and disseminationThis trial has been approved by the London – Central Research Ethics Committee. Findings will be disseminated to the academic community through peer-reviewed publications and presentation at national and international meetings. Patients will be informed of the results through patient organisations and newsletters to participants.Trial registration numberISRCTN13467772; Pre-results.

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Cardioplegia practice in paediatric cardiac surgery: a UK & Ireland survey

Cited by 10 publications

References 15 publications

Cardioplegia in Open Heart Surgery: Age Matters

Cardioplegia in Open Heart Surgery: Age Matters

Warm versus cold blood cardioplegia in paediatric congenital heart surgery: a randomized trial

Intermittent antegrade warm-blood versus cold-blood cardioplegia in children undergoing open heart surgery: a protocol for a randomised controlled study (Thermic-3)

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