Cardioplegia in Open Heart Surgery: Age Matters

Abstract

Introduction: Cardioplegia is a pharmacological approach essential for the protection of the heart from ischemia–reperfusion (I–R) injury. Over the years, numerous cardioplegic solutions have been developed, with each cardioplegic approach having its advantages and disadvantages. Cardioplegic solutions can be divided into crystalloid and blood cardioplegic solutions, and an experienced surgeon chooses the type of solution based on the individual needs of patients in order to provide optimal heart protection. Importantly, the pediatric immature myocardium is structurally, physiologically, and metabolically different from the adult heart, and consequently its needs to achieve cardioplegic arrest strongly differ. Therefore, the present review aimed to provide a summary of the cardioplegic solutions available to pediatric patients with a special focus on emphasizing differences in heart injury after various cardioplegic solutions, the dosing strategies, and regimens. Material and methods: The PubMed database was searched using the terms cardioplegia, I–R, and pediatric population, and studies that investigated the influence of cardioplegic strategies on markers of cardiac muscle damage were further analyzed in this review. Conclusions: A large body of evidence suggested more prominent benefits achieved with blood compared to those with crystalloid cardioplegia in pediatric myocardium preservation. However, standardized and uniform protocols have not been established so far, and an experienced surgeon chooses the type of cardioplegia solution based on the individual needs of patients, while the severity of myocardial damage strongly depends on the type and duration of the surgical procedure, overall patient condition, and presence of comorbidities, etc.

Comparison of Clinical Outcomes between del Nido Cardioplegia and Microplegia among Patients Undergoing Elective Mitral Valve Replacement

“…Crystalloid cardioplegia have been used for over 40 years in clinical practice and are subdivided into two groups as extracellular or intracellular according to the concentration of sodium, calcium, and magnesium. STH 1, STH 2, Celsior, Custodiol, University of Wisconsin, and Eurocollins are examples of crystalloid cardioplegia solutions [9]. Blood cardioplegia was introduced in the late 1970s and incorporates advantages of the blood such as, higher oxygen carrying capacity, increased microcirculatory perfusion linked with red blood cells, and the addition of free fatty acids that are used in anaerobic states [10].…”

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

“…For these reasons, mannitol is known as a nephrotoxic agent. The effect of cardioplegia is similar, as standard cardioplegic solutions are also hypertonic (300-375 mOsm/l) [90]. Cardioplegia is administered to the ostia of the coronary arteries, but eventually, it reaches systemic circulation through the cardiac veins and venous cannula of the CPB circuit.…”