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J Thorac Cardiovasc Surg 1997;114:1002-1009
© 1997 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

ANTEGRADE COLD BLOOD CARDIOPLEGIA IS NOT DEMONSTRABLY ADVANTAGEOUS OVER COLD CRYSTALLOID CARDIOPLEGIA IN SURGERY FOR CONGENITAL HEART DISEASE

Received for publication May 12, 1997 Revisions requested July 28, 1997 Revisions received August 25, 1997 Accepted for publication August 26, 1997 Address for reprints: J. Nilas Young, MD, Center for Cardiac Surgery, 2999 Regent St., Suite 626, Berkeley, CA 94705.

Abstract

Objective: The superiority of blood cardioplegia in pediatric cardiac surgery has not previously been challenged in a controlled clinical trial. The purpose of this study was to compare antegrade cold blood versus cold crystalloid cardioplegia in pediatric cardiac surgery. Methods: One hundred thirty-eight pediatric patients (mean age 32 months; 95% CL 24.2 to 39.8 months; range 1 day to 15 years) were prospectively randomized to receive either cold blood (4:1 dilution, blood/Plegisol, potassium chloride 15 mEq/L; n = 62) or cold crystalloid (Plegisol; n = 76) cardioplegic solution during a variety of operations for congenital heart disease. Multiple doses of cold (4° C) cardioplegic solution was administered antegradely in addition to topical cooling during ischemic arrest. Myocardial recovery and outcome measures were assessed by five clinical end points: (1) inotropic support, (2) echocardiographic assessment of ventricular function, (3) overall complication rate, (4) length of stay in the intensive care unit, and (5) 30-day survival. Multiple logistic regression and multivariate analysis of variance were used to investigate which of the following clinical determinants were contributory: (1) cardioplegia, (2) urgency of operation, (3) aortic crossclamp time, (4) age, and (5) cyanosis. Population data did not differ between the two cardioplegia groups ( p > 0.05). Results: The most important clinical determinant of studied end points was the aortic crossclamp time ( p < 0.05). The type of cardioplegic solution (blood vs crystalloid) was less important ( p > 0.05). The only statistically significant difference between blood and crystalloid cardioplegia for the measured clinical end points was the level of intraoperative inotropic support ( p < 0.05), although this did not correlate with any significant differences in measured ventricular function. Conclusion: Our results suggest no clear clinical advantage of antegrade cold blood cardioplegia over crystalloid cardioplegia during hypothermic cardioplegic arrest in pediatric cardiac surgery. The aortic crossclamp time was the strongest predictor of measured outcomes.

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