Cardiology Ecologic myocardial protection: Minicardioplegia

2010 B.Aguerrevere RN-CCP, J.Russo RN-CP, E.Medina RN-CP, J.Iribarren MD, A. Sanchez MD, A. Alaña MD, J.Castejon M.D.
Fundación De Todo Corazón Richard Gibson.
Hospital de Especialidades Pediátricas Maracaibo, Venezuela

Background
ABSTRACT OBJECTIVE METHODS RESULTS
Myocardial protection has always been a topic to discuss and a subject
where changes in paradigms are not seen so often. It is an important issue To share the experience of a team who ESP (Electrical Syringe Pump) Myocardial protection
of the surgical success that is reviewed and updated once in a while,
believes that when more physiologic
maybe because sometimes we take for granted the nobility and tolerance
to ischemia of the pediatric heart. the heart is treated protecting it Rate Nomogram strategy must balance the
complexity of: effectiveness,
Objectives: To share the experience of a team who believes that when with minicardioplegia, faster and
more physiologic the heart is treated protecting it with minicardioplegia, better the spontaneous activity simplicity, cost and
faster and better the spontaneous activity recovery will be WEIGHT TIME TO BE CONSTANT ESP evolution
Methods: From 2008-2009 we evaluated 96 patients undergoing CPB. recovery will be Kg DELIVERED C CC/HR
Mean complexity RACHS score: 2. Mean age was 3.7 years (3 month - 12 min
years) The average time of cardiopulmonary bypass (CPB) was 33.7 min.
(14 min-78 min), mean xclamp time was 21.2 min (7 min– 64 minutes)
Mean nasopharyngeal and rectal temps were 34.5 y 35 ºC respectively.
Pump prime consisted of Normosaline 0.9%, Sodium bicarbonate, heparin
and packed red blood cells to maintain a postdilutional hematocrit (Htc) of
DATA 1 - 15 2 14,12 WEIGHT X C

30%. Isotermic Miniplegia was given antegrade every 20 minutes to all

patients through a ¼ inch tubing line from the arterial port of the oxygenator # Patients Age (Years) CPB Time X Clamp Time Temperatures 16 - 30 3 9,41 WEIGHT X C
membrane to a Roller head and to a manifold were we connected 3 lines: 2008 - 2009 (min) (min) Naso/Rectal
1) Line pressure. 2) Table line with a bubble trap. 3) Line with a 20cc ºC
syringe, containing the arresting agents (Potassium K+ and Magnesium),
which were added to the blood cardioplegia circuit by means of an electrical 96 3.7 33.7 (14-78) 21.2 34.5/35 7,06
syringe pump (ESP). Flow rate (ml/hr) of the ESP was calculated through a (0.25- 12) (7-64) 31 - 45 4 WEIGHT X C
nomogram based on: Total blood volume to be delivered through the roller
head (20ml/kg), Time (minutes to deliver the blood volume) and target K+
concentration (20 meq/L for induction of arrest, 10 meq/L for its

Pump (CPB)
maintenance)
Results: Spontaneous recovery rhythm was achieved in a mean of 23
seconds for 95 patients after cross clamp removal. Defibrillation was
needed only for 1 case, no need of hemoconcentrator in all cases, final
mean Hct was 31.74% and average Potassium blood level post
minicardioplegia administration was 4.4 meq/l. ♥Saline Cc/hr formula: NOMOGRAM´S INSIGHT
Conclusions: Myocardial protection strategy must balance the complexity ♥Nahco3 Kg x 20cc x 20 meq/1000cc/0,85/timetbd* x 60s
of: effectiveness, simplicity, cost and evolution
Administering blood rather than crystalloid solutions into the myocardium Prime ♥PRBC / Postdilutional HCT 30%
provides nutrients to the muscle. Aerobic blood cardioplegia shifts the
oxyhemoglobin dissociation curve to the right. It has shown to be cost-
effective because its functional simplicity at low cost and has no impact in
the decision of the use of fluid removing devices like hemoconcentrators or
cell saving devices. Custom-made cardioplegia circuits with a heat
exchange integrated can also be used for this purpose. MINICARDIOPLEGIA
Minicardioplegia resulted for us: An ecological way of treating the heart
SET UP

ESP
Minicardioplegia resulted
for us: An ecologicalway of
meq 20 cc
K + 17
treating the heart.
MgSO 4 12 meq syringe *TimeTBD: time to be
• the complex of relations between a
specific organism and its environment
• bibliografia