Outcomes of Infant Cardiac Surgery Using Institutional vs Commercial Cardioplegia Solution: A Comparative Analysis

Background

This study assessed postoperative outcomes by using markers of myocardial injury in infants who received del Nido vs institutional cardioplegia solution.

Methods

Eighty-five infants undergoing cardiac surgery were enrolled (del Nido, n = 45; institutional, n = 40). Primary outcomes included serum troponin I, creatine kinase myocardial band (CK-MB), and heart fatty acid–binding protein on cardiothoracic intensive care unit (CTICU) admission and at 6, 12, and 24 hours postoperatively. Secondary outcomes included vasoactive inotropic score, arrhythmias, ventricular ejection fraction, ventilation hours, CTICU hours, hospital length of stay, and mortality.

Results

Patients receiving del Nido cardioplegia solution were older (174 days vs 105 days) and had higher body weight (5.95 kg vs 5.05 kg). They received greater cardioplegia volume and had longer bypass times. The del Nido cohort showed higher initial postoperative troponin I (1.53 times at admission; P = .02) and CK-MB levels (1.61 times on admission; P = .01; 1.51 times at 6 hours; P = .03; 1.55 times at 12 hours; P = .02) before normalizing. No differences were found in heart fatty acid–binding protein levels. Median postoperative hospital length of stay (5 days vs 7 days; P = .2) and CTICU stay (45 hours vs 70 hours; P = .077) were shorter for patients receiving the del Nido cardioplegia, although this was not statistically significant. No differences were observed in arrhythmias, ventricular ejection fraction, intubation time, or vasoactive inotropic score. There was no in-hospital or 30-day mortality.

Conclusions

The del Nido cardioplegia was associated with higher initial postoperative troponin I and CK-MB levels in infant cardiac surgery patients. However, no significant clinical outcome differences were found between the 2 solutions.