Effect of esmolol on myocardial protection in pediatrics congenital heart defects

Abstract

Background: Although it is accepted that inducing cardioplegia is the gold standard in myocardial protection, there is still no consensus on the exact type of the cardioplegia. There are fewer studies on the type of the cardioplegia in hearts of the children than adults and they are contradictory. The effects of esmolol have been reviewed (a type of ultrashort-acting beta-adrenergic antagonist, i.e., ß-blockers) in conjunction with the cardioplegia due to the effect of the β-blockers in reducing the myocardial ischemia and reperfusion.

Materials and methods: The left ventricle ejection fraction (LVEF), systolic blood pressure, central venous pressure (CVP), heart rate, etc., were recorded separately in patients who received the cardioplegia without esmolol (n = 35) and with esmolol (n = 30) and matched for the age and sex.

Results: The amount of inotrope used in the group without esmolol (100%) was considerably higher than in the group with esmolol (86.7%). Postoperative arrhythmias did not differ significantly between the two groups. There was no significant difference in the duration of cardiopulmonary bypass (CPB), time of the extubation, length of the ICU stay, the first day EF after surgery, and the first week EF after surgery as well. Creatinine kinase-MB (CKMB) was significantly higher in the group without esmolol during operation than in the group with esmolol.

Conclusions: The patients who received cardioplegia along with esmolol had less inotropic requirement after operation, and increase in EF and cardiac output (CO) 1 week after surgery. In addition, it reduced damage to the heart during surgery, and patients may have greater stability in the cardiac conduction system.

Keywords: Cardioplegia; esmolol; myocardial protection; pediatrics.