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J Thorac Cardiovasc Surg 2007;133:241-246
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Intermittent warm blood cardioplegia in the surgical treatment of congenital heart disease: Clinical experience with 1400 cases

Institut Hospitalier Jacques Cartier, Department of Pediatric Perfusion and Intensive Care, Massy, France.

Received for publication April 19, 2006; revisions received September 15, 2006; accepted for publication October 2, 2006.

^_* Address for reprints: Yves Durandy, MD, Institut Hospitalier Jacques Cartier, Avenue du Noyer Lambert 91300, Massy, France. (Email: iciprea{at}icip.org).

OBJECTIVE: To analyze our experience with warm blood cardioplegia in pediatric cardiac surgery.

METHODS: We used intermittent (every 15 minutes after initial injection) warm blood cardioplegia in the treatment of 1400 patients. Results were retrospectively compared with those of 950 patients treated with cold blood cardioplegia. The following parameters were analyzed: (1) hydric balance of cardioplegic solution; (2) resumption of rhythm after aortic crossclamp removal; (3) duration of mechanical ventilation, intensive care unit stay, and incidence of mortality in 4 selected diagnostic groups: ventricular septal defect, tetralogy of Fallot, atrioventricular septal defect, and transposition of the great arteries. These 4 groups, treated with warm or cold cardioplegia, were comparable with regard to age, weight, crossclamp times, and percent with Down syndrome; (4) troponin level at 12 hours after aortic crossclamping; and (5) duration of intensive care unit stay for the 1400 patients.

RESULTS: Warm versus cold cardioplegia: negligible fluid addition with warm cardioplegia compared with blood loss/prime dilution induced by cold cardioplegia; spontaneous resumption of sinus rhythm in 99% versus 77% of patients (P < .001); shorter duration of ventilatory support in each diagnostic group, significant in all cases; smaller increase in troponin in each group (P < .05). Incidence of early death was not different in the 2 groups. For the whole group, duration of the intensive care unit stay was less than 48 hours in 86% versus 75% (P < .001).

CONCLUSION: In our experience, normothermic cardioplegia has not generated any particular inconvenience and its use was contemporary, with improved outcomes.

This article has been cited by other articles:

				Y. D. Durandy, M. Younes, and B. Mahut Pediatric Warm Open Heart Surgery and Prolonged Cross-Clamp Time Ann. Thorac. Surg., December 1, 2008; 86(6): 1941 - 1947. [Abstract] [Full Text] [PDF]