Comparison of Myocardial Protection Between Del Nido and St. Thomas Cardioplegia in Paediatric Patients Underwent Surgical Repair for Congenital Heart Disease

Abstract

Background: Myocardial protection is a critical component of surgery in congenital heart disease (CHD). Since the commencement, several cardioplegia solutions have been developed to accomplish the goal. This study was aimed to compare the myocardial protection provided by Del Nido cardioplegia and St. Thomas cardioplegia solution in paediatric patients undergoing surgical repair for CHD.

Methods: This comparative cross-sectional study was carried out with a total of 30 paediatric patients who underwent elective cardiopulmonary bypass surgery for repair of congenital heart disease were included. They were divided into two groups: group-A (15 patients, who received Del Nido cardioplegia solution) and group-B (15 patients, who received St. Thomas cardioplegia solution). After surgery of all patients, biochemical markers (Troponin-I and Creatine Kinase MB) was done at 6th hour and 24th hour postoperatively and Vasoactive Inotropic Score (VIS) was taken immediately and at 24th hour postoperatively. pre and post operative left Ventricular Ejection Fraction (LVEF) was evaluated. Post operative events (Mechanical ventilation time, postoperative CICU stay period, postoperative hospital stay and complications) were recorded.

Results: The mean age, height, weight and body surface area were not statistically significant in both groups (p>0.05). Group-B patients had significantly higher cardiopulmonary bypass time (83.8±20.39 vs 106.87±31.33, p=0.022) and aortic cross clamp time (40.66±10.68 vs 50.73±12.10, p=0.020) than that of group A patients. Group-A patients had significantly lower value of Troponin-I (33.68±20.80 vs 268.15±297.48, p=0.005) and CK-MB (17.98±7.57 vs 49.66±52.32, p=0.035) after 24 hours of surgery. There was significantly higher number of patients in Group B, who had their Troponin-I (20% vs 73.33%, p = 0.003) and CK- MB (13.33% vs 60%, p = 0.008) at 24th postoperative hour in comparison to Group A. Besides, value of postoperative vasoactive inotropic score was significantly lower in group-A than group-B during immediately postoperative (11.81±3.03 vs 15.01±3.40, p=0.011) and at the 24th postoperative hour (9.1±2.73 vs 12.82±2.26, p<0.001).

Conclusion: Better myocardial protection is provided by Del Nido cardioplegia in comparison to St. Thomas cardioplegia in paediatric patients who underwent surgical repair for congenital heart disease. So, the application of Del Nido cardioplegia can minimize the morbidity and mortality with early postoperative recovery of the paediatric patients.

Cardiovasc j 2024; 17(1): 31-39