Myocardial Protection in Children

Abstract

The combination of hypothermia and potassium-based cardioplegic arrest has become the most common method of myocardial protection in the evolution of cardiac surgery. Since the 1980s, blood was added to cardioplegia solution in order to supply the myocardium with oxygen, nutrients, and for buffering purposes. Most cardiac operations are performed under cardioplegic arrest in pediatric cardiac surgery, and similar myocardial protection methods have been used in pediatric and adult patients for many years. However, the immature heart of a pediatric patient differs in many ways from the mature heart of an adult. Low cardiac output is observed more often in pediatric patients. Poor myocardial protection is still considered as a significant cause of hospital mortality in children. Today there are many different types of cardioplegia solutions and methods used in pediatric cardiac surgery. After the 1990s, normothermic perfusion and cardioplegia has been used in pediatric myocardial protection. Since 2010, the del Nido cardioplegic solution has been widely used which is generally administered in a single dose fashion. Myocardial protection may be more challenging in long and complex operations especially in which repeated cardioplegia delivery from the open aortic root is required, in newborn patients, or in preoperatively damaged myocardium. If the morbidity and mortality rate is high, particularly in long and complex procedures, revision of the myocardial protection method must be taken into account.