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DOI: 10.1055/s-0035-1544413
Improved Contractility with Modified Tepid Full Blood Cardioplegia Compared to Cold Crystalloid Cardioplegia in a Piglet Model
Objectives: Experience regarding warm blood cardioplegia according to Calafiore results from its broad use in adult patients. In this experimental study, tepid (28°C) modified full blood cardioplegia (MBC) was adopted for pediatric use and compared with cold crystalloid cardioplegia (CCC).
Methods: Twenty male piglets (mean weight 11.1 ± 1.0 kg) were operated on cardiopulmonary bypass (CPB) in moderate hypothermia (28°C) and randomized to MBC (n = 8) or CCC (n = 12) for 60 minutes aortic cross-clamping. Blood levels of myocardial proteins (NT-pro-BNP, myoglobin, CKMB, and troponin-I) were investigated at the beginning of the experiment and after CPB. Hemodynamic measurements were performed before (baseline) and after CPB by conductance-catheter inserted through the LV-apex. Pressure-volume-loop analysis was performed with dobutamine-stress test and inflow-occlusion enabling preload independent evaluation of myocardial performance. Changes of measured data post-CPB were calculated in relation to baseline-levels (%).
Results: Baseline and operative data in both groups were similar. During the experiment, cardiac markers showed no significant variations between groups. Pressure-volume loop analysis during stress-test revealed a positive trend toward a better cardiac output (MBC: 122 ± 16% [95% confidence interval (CI95): 109–135] vs CCC: 105 ± 17% [CI95: 93–116]; p = 0.069) and a significantly higher preload independent contractility (slope of end systolic pressure volume relation: Ees) with MBC compared with CCC (MBC: 123 ± 35% [CI95: 93–153] vs CCC: 78 ± 34% [CI95:54–102]; p = 0.042).
Conclusion: This randomized animal study proves feasibility and safety of MBC for pediatric use. Hemodynamic evaluation and cardiac markers did not show inferiority to standard CCC. Moreover, MBC seems to be associated with superior contractility post bypass, which encourages us to use MBC in pediatric patients in the near future.