Application comparison of paediatric myocardial protection procedures in arterial switch surgery
Münch F, Kohl M, Kwapil N, Dewald O, Cuomo M, Purbojo A (2024)
Publication Type: Journal article
Publication year: 2024
Journal
DOI: 10.1177/02676591241309842
Abstract
Background: Reliable myocardial protection is essential for a good outcome after arterial switch operation. Patients and Methods: We evaluated 56 neonates with arterial switch operation in this retrospective study. Three types of cardioplegia were used: antegrade Custodiol® (CCC) n = 22, antegrade Custodiol® plus paediatric microplegia (mix) n = 14, and antegrade plus retrograde intermittently paediatric microplegia (blood) n = 20. We evaluated the extent of myocardial injury using troponin I, Creatine kinase (CK), CK-MB (CK in myocardial cells) and vasoactive inotrope score (VIS), immediately- and the first postoperative day, as well as outcome parameters. A statistical analysis was conducted using multiple linear regression, with adjustments made for the RACHS score and ischemia time, at a significance level of 5%. Results: Preoperative data were comparable between the three groups. Aortic cross clamp time was significantly different between the three groups (CCC: 115 ± 26 min: mix: 162 ± 35 min: blood: 153 ± 31 min). We found significantly lower troponin I release in the blood group 14 ng/mL [CI95 10; 18] versus CCC group 36 ng/mL [CI95 27; 48] and versus mix group 27 ng/mL [CI95 19; 38]; troponin I 24 h blood group 8 ng/mL [CI95 6; 11] versus CCC group 14 ng/mL [CI95 10; 19]. No significant differences were found in CK, CK-MB, VIS, as well as in outcome parameters 30-day mortality, ventilation time, hospital stay or ECMO implantation. Conclusions: Intermittent paediatric microplegia led to a significantly lower release of troponin I, despite significantly longer ischemia times than after application of Custodiol®. Paediatric microplegia can be safely performed in neonates and also offers the advantage of miniaturization of the Cardiopulmonary bypass setup.
Authors with CRIS profile
Frank Münch
Medizinische Fakultät
Nicola Kwapil
Professur für Herzchirurgie mit dem Schwerpunkt Kinderherzchirurgie
Oliver Dewald
Department of Cardiac Surgery
Michela Cuomo
Department of Cardiac Surgery
Ariawan Purbojo
Department of Cardiac Surgery
Involved external institutions
Germany (DE)How to cite
APA:
Münch, F., Kohl, M., Kwapil, N., Dewald, O., Cuomo, M., & Purbojo, A. (2024). Application comparison of paediatric myocardial protection procedures in arterial switch surgery. Perfusion-Uk. https://doi.org/10.1177/02676591241309842
MLA:
Münch, Frank, et al. "Application comparison of paediatric myocardial protection procedures in arterial switch surgery." Perfusion-Uk (2024).
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