ANTEGRADE COLD BLOOD CARDIOPLEGIA IS NOT DEMONSTRABLY ADVANTAGEOUS OVER COLD CRYSTALLOID CARDIOPLEGIA IN SURGERY FOR CONGENITAL HEART-DISEASE

Objective: The superiority of blood cardioplegia in pediatric cardiac surgery has not previously been challenged in a controlled clinical tr ial. The purpose of this study was to compare antegrade cold blood ver sus cold crystalloid cardioplegia in pediatric cardiac surgery. Method s: One hundred thirty-eight pediatric patients (mean age 32 months; 95 % CL 24.2 to 39.8 months; range 1 day to 15 Sears) were prospectively randomized to receive either cold blood (1:1 dilution? blood/Plegisol, potassium chloride 15 mEq/L; n = 62) or cold crystalloid (Plegisol; n = 76) cardioplegic solution during a variety of operations for congen ital heart disease. Multiple doses of cold (4 degrees C) cardioplegic solution was administered antegradely in addition to topical cooling d uring ischemic arrest. Myocardial recovery and outcome measures n ere assessed by five clinical end points: (1) inotropic support, (2) echoc ardiographic assessment of ventricular function, (3) overall complicat ion rate, (3) length of stay in the intensive care unit, and (5) 30-da y survival. Multiple logistic regression and multivariate analysis of variance were used to investigate which of the following clinical dete rminants n ere contributory: (1) cardioplegia, (2) urgency of operatio n, (3) aortic crossclamp time, (4) age, and (5) cyanosis. Population d ata did not differ between the two cardioplegia groups (p > 0.05). Res ults: The most important clinical determinant of studied end points wa s the aortic crossclamp time (p < 0.05). The type of cardioplegic solu tion (blood vs crystalloid) was less important (p > 0.05). The only st atistically significant difference between blood and crystalloid cardi oplegia for the measured clinical end points mas the level of intraope rative inotropic support (p < 0.05), although this did not correlate w ith any significant differences in measured ventricular function. Conc lusion: Our results suggest no clear clinical advantage of antegrade c old blood cardioplegia over cystalloid cardioplegia during hypothermic cardioplegic arrest in pediatric cardiac surgery. The aortic crosscla mp time was the strongest predictor of measured outcomes.