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Ecologic myocardial protection:

Minicardioplegia

To be presented at Cardiology2010 conference Orlando, FlB.Aguerrevere RN-CCP, J.Russo RN-CP, E.Medina RN-CP, J.IribarrenMD, A. Sanchez MD, A. Alaña MD, J.Castejon M.D.Fundación De Todo Corazón Richard Gibson.Hospital de Especialidades Pediátricas Maracaibo, VenezuelaBackgroundMyocardial protection has always been a topic to discuss and asubject where changes in paradigms are not seen so often. It is animportant issue of the surgical success that is reviewed and updatedonce in a while, maybe because sometimes we take for granted thenobility and tolerance to ischemia of the pediatric heart.ObjectivesTo share the experience of a team who believes that when morephysiologic the heart is treated protecting it with minicardioplegia,faster and better the spontaneous activity recovery will be.MethodsFrom 2008-2009 we evaluated 96 patients undergoing CPB. Meancomplexity RACHS score: 2. Mean age was 3.7 years (3 month - 12years) The average time of cardiopulmonary bypass (CPB) was 33.7min. (14 min-78 min), mean xclamp time was 21.2 min (7 min– 64minutes) Mean nasopharyngeal and rectal temps were 34.5 y 35

ºC

respectively. Pump prime consisted of Normosaline 0.9%, Sodiumbicarbonate, heparin and packed red blood cells to maintain apostdilutional hematocrit (Htc) of 30%.Isotermic Miniplegia was given antegrade every 20 minutes to allpatients through a ¼ inch tubing line from the arterial port of theoxygenator membrane to a Roller head and to a manifold were weconnected 3 lines:1) Line pressure. 2) Table line with a bubble trap. 3) Line with a 20ccsyringe, containing the arresting agents

(Potassium K

andMagnesium), which

were added to the blood cardioplegia circuit bymeans of an electrical syringe pump (ESP). Flow

rate (ml/hr) of theESP was calculated through a nomogram based on: Total bloodvolume 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 maintenance)Results