Original Article

Does Cardioplegic Protection of the Pediatric Patient Heart Vary According to the Cardiac Defect?

^* Address correspondence to: Alfred H. Stammers, B.S.,C.C.P. Department of Extracorporeal Technology, College of Health Related Professions, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC, 29425

Abstract

The technique of myocardial protection utilized during pediatric cardiac surgery may be influenced by the congenital lesion, and be related to the pathophysiological changes associated with myocardial dysfunction and altered systemic and pulmonary circulations. The present study is a retrospective examination of the cardioplegic and cardiopulmonary bypass parameters utilized during pediatric cardiac surgery.

1016 pediatric patients were subdivided according to cardiac lesion, with the following parameters recorded: Age at operation, weight, body surface area, cardioplegia (CP) volume administered, cardioplegia dose schedule, cardiopulmonary bypass and cross clamp times, and low perfusate temperature. Cardioplegia volume administration was indexed according to weight and body surface area and patients were categorized as being either acyanotic or cyanotic The following results (Mean ±SEM) were obtained between groups not significantly different in respect to weight and body surface area:

Patients with pulmonary obstructive lesions had significantly more cardioplegic volume administered than certain acyanotic lesions. This may reflect a greater susceptibility to ischemic and reperfusion related phenomena in cyanotic compared to acyanotic patients. Cardioplegic protection of the pediatric heart may be influenced by multiple factors related to the cardiac lesion, necessitating preferential preservation strategies.