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Review
. 2023 Feb 20;12(4):1698.
doi: 10.3390/jcm12041698.

Cardioplegia in Open Heart Surgery: Age Matters

Jovana Bradić  1   2 , Marijana Andjić  1   2 , Jovana Novaković  1   2 , Nevena Jeremić  1   2   3 , Vladimir Jakovljević  2   4   5
Affiliations
Review

Cardioplegia in Open Heart Surgery: Age Matters

Jovana Bradić et al. J Clin Med. .

Abstract

Introduction: Cardioplegia is a pharmacological approach essential for the protection of the heart from ischemia-reperfusion (I-R) injury. Over the years, numerous cardioplegic solutions have been developed, with each cardioplegic approach having its advantages and disadvantages. Cardioplegic solutions can be divided into crystalloid and blood cardioplegic solutions, and an experienced surgeon chooses the type of solution based on the individual needs of patients in order to provide optimal heart protection. Importantly, the pediatric immature myocardium is structurally, physiologically, and metabolically different from the adult heart, and consequently its needs to achieve cardioplegic arrest strongly differ. Therefore, the present review aimed to provide a summary of the cardioplegic solutions available to pediatric patients with a special focus on emphasizing differences in heart injury after various cardioplegic solutions, the dosing strategies, and regimens.

Material and methods: The PubMed database was searched using the terms cardioplegia, I-R, and pediatric population, and studies that investigated the influence of cardioplegic strategies on markers of cardiac muscle damage were further analyzed in this review.

Conclusions: A large body of evidence suggested more prominent benefits achieved with blood compared to those with crystalloid cardioplegia in pediatric myocardium preservation. However, standardized and uniform protocols have not been established so far, and an experienced surgeon chooses the type of cardioplegia solution based on the individual needs of patients, while the severity of myocardial damage strongly depends on the type and duration of the surgical procedure, overall patient condition, and presence of comorbidities, etc.

Keywords: cardioplegia; ischemia–reperfusion; pediatric population.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Differences in the pediatric and adult myocardium.
Figure 2
Figure 2
Cardioplegia as a tool for heart preservation throughout history.
Figure 3
Figure 3
Targets for achieving depolarized and polarized arrest.
See this image and copyright information in PMC

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