Paediatric myocardial protection-strategies, controversies and recent developments

Talwar, Sachin; Jha, Aandrei Jivendra; Hasija, Suruchi; Choudhary, Shiv Kumar; Airan, Balram

doi:10.1007/s12055-013-0208-2

Cited by 6 publications

(6 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Promotion of anaerobic glycolysis, scavenging of oxygen-free radicals, and prevention of intracellular calcium accumulation are probably the keys to myocardial protection during the period of arrest. [3][4][5] del Nido cardioplegia solution is a unique formulation of 4 parts crystalloid to one part whole blood, which is generally used in a single-dose fashion. 6 Because of its unique properties, aortic crossclamping for up to 3 h has been achieved safely without any ventricular electrical activity.…”

Section: Introductionmentioning

confidence: 99%

Myocardial protection following del Nido cardioplegia in pediatric cardiac surgery

Panigrahi

Roychowdhury

Guhabiswas

et al. 2018

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Background This study was designed to compare myocardial protection with del Nido cardioplegia and conventional blood cardioplegia in children undergoing cardiac surgery in Risk Adjustment for Congenital Heart Surgery categories 1 and 2. Methods Sixty patients were randomized into 2 groups receiving del Nido cardioplegia solution or conventional blood cardioplegia. Myocardial injury was assessed using biochemical markers (troponin I and creatine kinase-MB). Vasoactive-inotropic scores were calculated to compare inotropic requirements. Results Demographic characteristics, cardiopulmonary bypass time, and aortic crossclamp time were comparable in the 2 groups. Time-related changes in troponin I and creatine kinase-MB were similar in both groups. Statistically significant differences were seen in total cardioplegia volume requirement ( p < 0.0001), number of cardioplegia doses given ( p < 0.0001), packed red cell volume usage during cardiopulmonary bypass ( p < 0.02), and time taken to restore spontaneous regular rhythm ( p < 0.0001). Vasoactive-inotropic scores on transfer to the intensive care unit ( p < 0.040) and at 24 h ( p < 0.030) were significantly lower in the del Nido group. Duration of mechanical ventilation, intensive care unit stay, and hospital stay were comparable in the 2 groups. Conclusions Our results show that del Nido cardioplegia solution is as safe as conventional blood cardioplegia. Moreover, it provides the benefits of reduced dose requirement, lower consumption of allogenic blood on cardiopulmonary bypass, quicker resumption of spontaneous regular cardiac rhythm, and less inotropic support requirement on transfer to the intensive care unit and at 24 h, compared to conventional blood cardioplegia.

show abstract

Section: Introductionmentioning

confidence: 99%

Myocardial protection following del Nido cardioplegia in pediatric cardiac surgery

Panigrahi

Roychowdhury

Guhabiswas

et al. 2018

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

show abstract

“…Skilled surgical techniques, vigilant monitoring and meticulous attention to detail are essential in mitigating these potential complications 23. In congenital heart surgery, common measures of myocardial protection include use of cardioplegia to arrest the heart, hypothermia to reduce metabolic demands and administration of oxygenated blood through a cardiopulmonary bypass machine, which ensures adequate oxygen supply to the heart while the surgical repair or correction is performed 24…”

Section: Discussionmentioning

confidence: 99%

Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysis

Furnaz,

Shaikh,

Qureshi

et al. 2023

BMJ Open

View full text Add to dashboard Cite

ObjectiveThis study aimed to assess the International Quality Improvement Collaborative single-site data from a developing country to identify trends in outcomes and factors associated with poor outcomes.DesignRetrospective descriptive study.SettingThe National Institute of Cardiovascular Diseases, Karachi, Pakistan.ParticipantsPatients undergoing surgery for congenital heart disease (CHD).Outcome measureKey factors were examined, including preoperative, procedural and demographic data, as well as surgical complications and outcomes. We identified risk factors for mortality, bacterial sepsis and 30-day mortality using multivariable logistic regression.ResultsA total of 3367 CHD surgical cases were evaluated; of these, 59.4% (2001) were male and 82.8% (2787) were between the ages of 1 and 17 years. Only 0.2% (n=6) were infants (≤30 days) and 2.3% (n=77) were adults (≥18 years). The in-hospital mortality rate was 6.7% (n=224), and 4.4% (n=147) and 0.8% (n=27) had bacterial sepsis and surgical site infections, respectively. The 30-day status was known for 90.8% (n=3058) of the patients, of whom 91.6% (n=2800) were alive. On multivariable analysis, the adjusted OR for in-hospital mortality was 0.40 (0.29–0.56) for teenagers compared with infancy/childhood and 1.95 (1.45–2.61) for patients with oxygen saturation <85%. Compared with Risk Adjustment for Congenital Heart Surgery (RACHS-1) risk category 1, the adjusted OR for in-hospital mortality was 1.78 (1.1–2.87) for RACHS-1 risk category 3 and 2.92 (1.03–8.31) for categories 4–6. The adjusted OR for 30-day mortality was 0.40 (0.30–0.55) for teenagers and 1.52 (1.16–1.98) for patients with oxygen saturation <85%. The 30-day mortality rate was significantly higher in RACHS-1 risk category 3 compared with category 1, with an adjusted OR of 1.64 (1.06–2.55).ConclusionsWe observed a high prevalence of postoperative infections and mortality, especially for high-risk procedures, according to RACHS-1 risk category, in infancy/childhood, in children with genetic syndrome or those with low oxygen saturation (<85%).

show abstract

“…Younger age at the time of surgery is considered a significant risk factor for adverse postoperative outcomes, including myocardial injury, cardiac arrhythmias, and depressed mechanical function [3][4][5] . As such, intraoperative injury and/or postoperative recovery can be influenced by the structural, functional, and metabolic immaturity of the pediatric myocardium 6 . A more detailed understanding of cardiac maturation will help to expand our knowledge on cardiac diseases that develop during gestation, identify age-appropriate cardiovascular drug therapies, and inform clinical care decisions related to surgical repair, myocardial preservation, or postoperative management.…”

Section: Introductionmentioning

confidence: 99%

Connecting Transcriptomics with Computational Modeling to Reveal Developmental Adaptations in the Human Pediatric Myocardium

Salameh,

Guerrelli,

Miller

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Nearly 1% or 1.3 million babies are born with CHD globally each year, many of whom will require palliative or corrective heart surgery within the first few years of life. A detailed understanding of cardiac maturation can help to expand our knowledge on cardiac diseases that develop during gestation, identify age-appropriate cardiovascular drug therapies, and inform clinical care decisions related to surgical repair, myocardial preservation, or postoperative management. Yet, to date, our knowledge of the temporal changes that cardiomyocytes undergo during postnatal development is largely limited to animal models. Methods: Right atrial tissue samples were collected from n=117 neonatal, infant, and pediatric patients undergoing correct surgery due to (acyanotic) congenital heart disease (CHD). Patients were stratified into five age groups: neonate (0-30 days), infant (31–364 days), toddler to preschool (1–5 years), school age (6–11 years), and adolescent to young adults (12–32 years). We measured age-dependent adaptations in cardiac gene expression, and used computational modeling to simulate action potential and calcium transients. Results: Enrichment of differentially expressed genes (DEG) was explored, revealing age-dependent changes in several key biological processes (cell cycle, cell division, mitosis), cardiac ion channels, and calcium handling genes. Gene–associated changes in ionic currents exhibited both linear trends and sudden shifts across developmental stages, with changes in calcium handling (INCX) and repolarization (IK1) most strongly associated with an age-dependent decrease in the action potential plateau potential and increase in triangulation, respectively. We also note a shift in repolarization reserve, with lower IKr expression in younger patients, a finding likely tied to the increased amplitude of IKs triggered by elevated sympathetic activation in pediatric patients. Conclusion: This study provides valuable insights into age–dependent changes in human cardiac gene expression and electrophysiology among patients with CHD, shedding light on molecular mechanisms underlying cardiac development and function across different developmental stages.

show abstract

Paediatric myocardial protection-strategies, controversies and recent developments

Cited by 6 publications

References 54 publications

Myocardial protection following del Nido cardioplegia in pediatric cardiac surgery

Myocardial protection following del Nido cardioplegia in pediatric cardiac surgery

Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysis

Connecting Transcriptomics with Computational Modeling to Reveal Developmental Adaptations in the Human Pediatric Myocardium

Contact Info

Product

Resources

About