WARM CONTINUOUS ANTEGRADE BLOOD CARDIOPLEGIA - APPLICATIONS IN CONGENITAL HEART-DISEASE

Continuous warm blood cardioplegia is utilized by many surgeons as the ir method of choice for myocardial protection during operations for ac quired heart disease. Objective: this study was performed to determine the feasibility and safety of this method for intracardiac procedures through the right atrium and in particular, total cavopulmonary conne ction. Materials and methods: procedures included closure of an atrial septal defect (23), atrial septectomy (2) and total cavopulmonary con nection (4). Antegrade blood cardioplegia was delivered continuously f or an average of 27 +/- 21 minutes at an average flow of 130 +/- 60 cc /min to maintain the aortic root pressure between 60 and 80 mmHg (mean 74 +/- 5 mmHg). Perfusion with regular blood commenced in the last 2 to 8 minutes and complete de-airing procedure was performed on the bea ting heart before removal of the aortic cross-clamp. Results: all pati ents resumed sinus rhythm and all but one had normal cardiac output po stoperatively. In one patient after cavopulmonary connection the infer ior vena-cava to pulmonary-artery connection was taken down because of increased pulmonary vascular resistance resulting in low output state . All patients made an uneventful recovery without neurological compli cations. Conclusions: this initial experience suggests that normotherm ic aerobic arrest can be used safely in the repair of congenital defec ts and may provide superior myocardial protection for complex procedur es such as the Fontan procedure.