title: Improved contractility with tepid modified full blood cardioplegia compared with cold crystalloid cardioplegia in a piglet model.
abstract: OBJECTIVE
  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 paediatric 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 min aortic cross-clamping. Blood levels of myocardial proteins [N-terminal pro-brain natriuretic peptide (NT-pro-BNP), myoglobin, creatine kinase type MB and troponin-I] were investigated at the beginning of the experiment and after CPB. Haemodynamic measurements included thermodilution and conductance-catheter technique inserted through the left ventricle-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 significantly higher preload independent contractility (slope of end-systolic pressure-volume relation: Ees) with MBC compared with CCC (MBC: 123 ± 35% [confidence interval (CI95): 93-153] vs CCC: 78 ± 34% [CI95: 54-102]; P = 0.042), whereas cardiac output was not significantly different between groups {MBC: 122 ± 16% [95% confidence interval (CI95): 109-135] vs CCC: 105 ± 17% [CI95: 93-116]; P = 0.069}.
  
  
  CONCLUSIONS
  This randomized animal study proves feasibility and safety of MBC for paediatric use. Haemodynamic 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 paediatric patients in the near future.
authors.affiliation: Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Münch
authors.affiliation: Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Ariawan
authors.initials: A
authors.lastname: Purbojo
authors.affiliation: Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kellermann
authors.affiliation: Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Carina
authors.initials: C
authors.lastname: Janssen
authors.affiliation: Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Robert Anton
authors.initials: RA
authors.lastname: Cesnjevar
authors.affiliation: Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany andre.rueffer@uk-erlangen.de.
authors.forename: André
authors.initials: A
authors.lastname: Rüffer
mesh_terms: D000367:Age Factors; D000818:Animals; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D000077324:Crystalloid Solutions; D004195:Disease Models, Animal; D006324:Heart Arrest, Induced / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D011897:Random Allocation; D034421:Sus scrofa; D013696:Temperature
chemical_list: D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: Blood cardioplegia; Calafiore; Cold crystalloid; Congenital; Contractility