title: The effect of tepid amino acid-enriched induction cardioplegia on the outcome of infants undergoing cardiac surgery.
abstract: BACKGROUND
  Despite promising experimental results, no information has been published on the clinical effects of amino acid-enriched induction cardioplegic solution on outcome in children undergoing cardiac surgery.
  
  
  METHODS
  This is a retrospective study of 185 consecutive patients younger than 12 months with one of the following defects undergoing open heart surgery: atrioventricular septal defect, transposition of the great arteries, tetralogy of Fallot or ventricular septal defect. Patients were divided into two groups according to the following myocardial protection approaches: tepid substrate-enriched induction cardioplegia followed by cold blood cardioplegia (n=113) or only cold blood induction cardioplegia (n=72). Patient allocation was determined by the anesthesiologist in charge of cardiopulmonary bypass (CPB). The primary outcome measure was postoperative myocardial injury assessed by troponin T level and inotrope score.
  
  
  RESULTS
  Demographic data were similar for both groups. Cardioplegic induction had no overall effect for inotrope score (16.3 ± 9.2 vs.17.9 ± 10.0, p=0.276) or lactate release (1.8 ± 1.3 vs. 1.6 ± 0.8, p=0.110) on arrival to the paediatric intensive care unit. On the first postoperative day, there were no significant differences between the cardioplegia groups for inotrope score (13.7 ± 8.7 vs.14.3 ± 9.1, p=0.657), troponin T (2.4 ± 1.6 vs. 2.8 ± 2.7 μg/L, p=0.267), lactate (1.5 ± 2.0 vs. 1.5 ± 0.8, p=0.972), or any of the other clinical outcome measures.
  
  
  CONCLUSIONS
  Compared to cold cardioplegia alone, the administration of tepid induction cardioplegia had no effect on the clinical outcome of infants who underwent cardiac surgery.
authors.affiliation: Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. pertti.suominen@hus.fi
authors.forename: P K
authors.initials: PK
authors.lastname: Suominen
authors.forename: J
authors.initials: J
authors.lastname: Keski-Nisula
authors.forename: P
authors.initials: P
authors.lastname: Tynkkynen
authors.forename: S
authors.initials: S
authors.lastname: Kantoluoto
authors.forename: K T
authors.initials: KT
authors.lastname: Olkkola
authors.forename: L
authors.initials: L
authors.lastname: Mildh
mesh_terms: D000596:Amino Acids / Q000008:administration & dosage*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
chemical_list: D000596:Amino Acids