title: Antegrade cold blood cardioplegia is not demonstrably advantageous over cold crystalloid cardioplegia in surgery for congenital heart disease.
abstract: OBJECTIVE
  The superiority of blood cardioplegia in pediatric cardiac surgery has not previously been challenged in a controlled clinical trial. The purpose of this study was to compare antegrade cold blood versus cold crystalloid cardioplegia in pediatric cardiac surgery.
  
  
  METHODS
  One hundred thirty-eight pediatric patients (mean age 32 months; 95% CL 24.2 to 39.8 months; range 1 day to 15 years) were prospectively randomized to receive either cold blood (4:1 dilution, blood/Plegisol, potassium chloride 15 mEq/L; n = 62) or cold crystalloid (Plegisol; n = 76) cardioplegic solution during a variety of operations for congenital heart disease. Multiple doses of cold (4 degrees C) cardioplegic solution was administered antegradely in addition to topical cooling during ischemic arrest. Myocardial recovery and outcome measures were assessed by five clinical end points: (1) inotropic support, (2) echocardiographic assessment of ventricular function, (3) overall complication rate, (4) length of stay in the intensive care unit, and (5) 30-day survival. Multiple logistic regression and multivariate analysis of variance were used to investigate which of the following clinical determinants were contributory: (1) cardioplegia, (2) urgency of operation, (3) aortic crossclamp time, (4) age, and (5) cyanosis. Population data did not differ between the two cardioplegia groups (p > 0.05).
  
  
  RESULTS
  The most important clinical determinant of studied end points was the aortic crossclamp time (p < 0.05). The type of cardioplegic solution (blood vs crystalloid) was less important (p > 0.05). The only statistically significant difference between blood and crystalloid cardioplegia for the measured clinical end points was the level of intraoperative inotropic support (p < 0.05), although this did not correlate with any significant differences in measured ventricular function.
  
  
  CONCLUSIONS
  Our results suggest no clear clinical advantage of antegrade cold blood cardioplegia over crystalloid cardioplegia during hypothermic cardioplegic arrest in pediatric cardiac surgery. The aortic crossclamp time was the strongest predictor of measured outcomes.
authors.affiliation: Division of Cardiothoracic Surgery, Children's Hospital, Oakland, Calif., USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Young
authors.forename: I O
authors.initials: IO
authors.lastname: Choy
authors.forename: N K
authors.initials: NK
authors.lastname: Silva
authors.forename: D Y
authors.initials: DY
authors.lastname: Obayashi
authors.forename: H E
authors.initials: HE
authors.lastname: Barkan
mesh_terms: D001639:Bicarbonates; D001769:Blood; D002122:Calcium Chloride; D002314:Cardioplegic Solutions; D002675:Child, Preschool; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D007902:Length of Stay; D016015:Logistic Models; D008274:Magnesium; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011189:Potassium Chloride; D011446:Prospective Studies; D012965:Sodium Chloride; D013997:Time Factors
chemical_list: D001639:Bicarbonates; D002314:Cardioplegic Solutions; C041711:St. Thomas' Hospital cardioplegic solution; D012965:Sodium Chloride; D011189:Potassium Chloride; D008274:Magnesium; D002122:Calcium Chloride