SINGLE-SHOT COLD HISTIDINE-TRYPTOPHAN-KETOGLUTARATE CARDIOPLEGIA FOR LONG AORTIC CROSS-CLAMPING DURATIONS IN NEONATES

ABSTRACT Objective More than 30% of European pediatric cardiac surgery centres use single-dose cold histidine-tryptophan-ketoglutarate cardioplegia (Custodiol). In neonates with transposition of the great arteries, the arterial switch operation (ASO) implies aortic division, and it is not known whether or not repeated ostial cannulation causes intimal insult and affects long-term results. Single-dose Custodiol is appealing, therefore. This work investigates the association between myocardial no-flow duration, postoperative troponins, and post-operative outcomes in neonates undergoing ASO with Custodiol cardioplegia. Design retrospective analysis of the association between the myocardial no-flow duration, post-operative troponin release (concentration magnitude * measurement duration within 48 hours) and outcomes, using stratification according to coronary anatomy and attending surgeon Setting single-institutional, tertiary pediatric cardiac surgery unit of a University Hospital Participants 101 neonates undergoing the ASO Interventions none Measurements and Main Results mean age 6.1±5.4 days, cardiopulmonary bypass duration 108.7±54.1 min, temperature during cross-clamping 31.1±1.7°C, duration of mechanical ventilation 4[3-6] days, ICU stay 7[5-8] days, delayed sternal closure 32(31.7%), none died. The myocardial no-flow duration averaged 62.3±14.6 min, and was linked with both troponin release (p=0.04) and low cardiac output syndrome, as assessed by the requirement for delayed sternal closure (p=0.03), regardless of CPB duration and temperature. 82% of the patients with myocardial no-flow duration >74 min required delayed sternal closure. Conclusions Single dose Custodiol may be inadequate for prolonged cross-clamping durations without myocardial perfusion in neonates.