Modifizierte Blutkardioplegie nach Calafiore im Vergleich zu kalter kristalloider Kardioplegie bei der Korrektur einfacher Septumdefekte

Objectives: A significant number of scientific articles in peer reviewed journals focus on myocardial protection by comparing cold cristalloid and warm blood cardioplegia in adults. Only few studies have compared both concepts in the context of pediatric heart surgery and their results are contradictory. There is currently no evidence in favor of one or the other technique. Cardiac surgeons at the University Hospital of Erlangen have established two different cardioplegic solutions for congenital open heart procedures: Bretschneider´s solution, a cold cristalloid cardioplegia, and tepid modified full blood cardioplegia (Calafiore- blood-cardioplegia adapted for pediatric use). Comparing both solutions in animal studies has shown significantly improved contractility and less metabolic derangement after using blood cardioplegia. Consecutive studies on pediatric patients haven´t been published yet. The aim of the present work was to show the safety and feasibility of tepid modified blood cardioplegia for pediatric use during surgical treatment of simple septal defects. Furthermore, if existing, possible advantages of one solution should be determined. Methods: Data of 64 surgical low- risk patients undergoing elective repair of simple septal defects between 2010 and 2015 were retrospectively analyzed. Patients were paired by diagnosis and body surface area. Each group contained of 15 patients with ventricular septal defect, 12 patients with atrial septal defect and 5 patients with partial anomalous pulmonary venous return. Corrective surgery was either performed with cristalloid cardioplegia or blood cardioplegia. Different clinical parameters served for comparison of both solutions in terms of feasibility and myocardial protection. Cardiac index and cardiac output were evaluated. Serum concentrations of specific cardiac markers were determined (Troponin I, Troponin T, Creatine Kinase type MB) and arterial blood gases were analyzed for lactate. Results: Both groups had similar preoperative patient characteristics in terms of age, weight and size. No differences were found between the groups with regard to time on cardiopulmonary bypass, aortic crossclamping time and lowest body temperature. There were no significant statistical differences between patients operated with blood or cold cristalloid cardioplegia. Postoperative measurements of cardiac index, cardiac proteins and lactate in both groups showed no significant difference. Conclusion: Tepid modified full blood cardioplegia is safe and effective for myocardial protection during repair of simple septal defects in infants and young children. There is no clear clinical advantage of blood cardioplegia over cristalloid cardioplegia as myocardial protective strategy in pediatric cardiac surgery. However, some theoretical advantages of blood cardioplegia, and the evidence of other studies showing a significant benefit for cyanotic patients or for patients with longer crossclamp times, may indicate a preferable use of blood cardioplegia for this patient subset