Pediatric Myocardial Protection

Pearl, Jeffrey M.; Duffy, Jodie Y.; McLean, Karen

doi:10.1007/978-1-84800-923-3_15

Cited by 2 publications

(5 citation statements)

References 87 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This simple and efficient method for myocardial protection has gained acceptance for normothermic adult cardiac surgery since the late 1990s. The advantages of blood in comparison with crystalloid solutions [3,13] as well as the possibility to adopt moderate hypothermia (28°C) for both systemic and cardioplegic infusion have driven us to modify Calafiore's blood cardioplegia for paediatric hearts. The difference regarding electrolyte composition of MBC consists in further enrichment with 20% more potassium and 25% more magnesium as opposed to the adult formula.…”

Section: Discussionmentioning

confidence: 99%

“…Blood, unlike crystalloid solutions, carries oxygen, nutrients and energy to the cells and organs. It combines natural buffering capacity and ideal colloid-osmotic pressure with physiological rheology, which has a positive effect on the degree of oedema [3][4][5]. Additionally, high-energy phosphate, oxygen and anti-oedematous substrates are delivered to myocardial tissue, and free radicals and degradation products are washed out by repeated administration of blood cardioplegia every 20 min.…”

Section: Introductionmentioning

confidence: 99%

“…Considering the differences between immature and mature hearts with regard to the energetic requirements and electrolyte balance makes it potentially dangerous to just transfer the current method of Calafiore from adult heart surgery to neonates and infants [3,6,7]. Therefore, we modified Calafiore's blood cardioplegia (MBC) by adopting the electrolyte composition for paediatric use.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Improved contractility with tepid modified full blood cardioplegia compared with cold crystalloid cardioplegia in a piglet model

Münch

Purbojo

Kellermann

et al. 2014

Eur J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Improved contractility with tepid modified full blood cardioplegia compared with cold crystalloid cardioplegia in a piglet model

Münch

Purbojo

Kellermann

et al. 2014

Eur J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…7 In neonatal hearts, Ca control during the ischaemic and reperfusion phases is of paramount importance to prevent Cainduced cellular damage. 8 The specific characteristics in these diseased hearts were considered when compiling paediatric microplegia. The basis for paediatric microplegia have been elaborated on, in an animal experimental study by Münch et al 9,10 This Practical Technique article describes the clinical implementation of concentration-dependent paediatric microplegia across the entire patient population.…”

Section: Introductionmentioning

confidence: 99%

“… 7 In neonatal hearts, Ca control during the ischaemic and reperfusion phases is of paramount importance to prevent Ca-induced cellular damage. 8 …”

Section: Introductionmentioning

confidence: 99%

Microplegia in paediatric hearts

et al. 2022

View full text Add to dashboard Cite

Introduction A basic prerequisite for a good surgical outcome in heart surgery is optimal myocardial protection. However, cardioplegia strategies used in adult cardiac surgery are not directly transferable to infant hearts. Paediatric microplegia, analogous to Calafiore cardioplegia used in adult cardiac surgery, offers the advantage of safe myocardial protection without haemodilution. The use of concentration-dependent paediatric microplegia is new in clinical implementation. Material and methods Paediatric microplegia has been in clinical use in our institution since late 2014. It is applied via an 1/8 inch tube of a S5-HLM roller pump (LivaNova, Italy). As cardioplegic additive, a mixture of potassium (K) 20 mL (2 mmol/mL potassium chloride 14.9% Braun) and magnesium (Mg) 10 mL (4 mmol/mL Mg-sulphate Verla® i. v. 50%) is fixed into a syringe-pump (B. Braun, Germany). This additive is mixed with arterial patient blood from the oxygenator in different flow dependent ratios to form an effective cardioplegia. Technique After microplegia application of initially 25 mmol/L K with 11 mmol/L Mg for 2 min, a safe cardioplegic cardiac arrest is achieved, which after release of the coronary circulation, immediately returns to a spontaneous cardiac-rhythm. In the case of prolonged aortic clamping, microplegia is repeated every 20 min with a reduction of the application dose of K by 20% and Mg by 30% (20 mmol/L K; 8.5 mmol/L Mg) and a further reduction down to a maintenance dose (15 mmol/L K; 6 mmol/L Mg) after additional 20 min. Summary The microplegia adapted to the needs of paediatric myocardium is convincing due to its simple technical implementation for the perfusionist while avoiding haemodilution. However, the required intraoperative interval of microplegia of approx. 20 min demands adapted intraoperative management from the surgeon.

show abstract

Pediatric Myocardial Protection

Cited by 2 publications

References 87 publications

Improved contractility with tepid modified full blood cardioplegia compared with cold crystalloid cardioplegia in a piglet model

Improved contractility with tepid modified full blood cardioplegia compared with cold crystalloid cardioplegia in a piglet model

Microplegia in paediatric hearts

Contact Info

Product

Resources

About