Iranian Heart Journal

Iranian Heart Journal

Impact of Reducing Intervals Between Two Cardioplegia Injections on Clinical Outcomes Among Pediatrics Undergoing Cardiopulmonary Bypass: A Randomized Clinical Trial

Document Type : Original Article

Authors
Amirhossein Jalali 1
Maziar Gholampour Dehaki 1
Yalda Asheghi 1
Naser Kachoueian 2
Alireza Yaghoubi 1
Soha Sadeghpour 3
Farshad Jalili Shahandashti 1
Zahra Serajpour 3
Farhad Gorjipour 1
Fazel Gorjipour 4
1 Rajaie Cardiovascular Institute, Iran University of Medical Sciences, Tehran, IR Iran.
2 Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
3 Nilou Medical Laboratory, Tehran, IR Iran.
4 Iran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: The use of a cardiopulmonary bypass machine during heart surgery can increase the risk of myocardial damage, as indicated by elevated levels of troponin I and creatine phosphokinase markers. Therefore, there is a need to reduce ischemia-reperfusion injury following pediatric cardiopulmonary bypass surgery. It appears that myocardial damage may be mitigated by shortening the intervals between cardioplegia injections.
 
Methods: This randomized controlled trial was conducted on pediatric patients undergoing surgery for Tetralogy of Fallot. Participants were randomly assigned to either an intervention group or a control group using the block randomization method. In the intervention group, the interval between 2 doses of Del Nido cardioplegia was reduced to 40 minutes, while patients in the control group received Del Nido cardioplegia every 60 minutes. Data for the trial were collected using checklists prepared by the researcher.
 
Results: The study findings indicated that, although the mean levels of troponin and phosphokinase were significantly lower in the trial group compared with the control group, the changes in both markers across different measurement times were similar in both groups. Most other clinical outcome parameters of heart surgeries, such as left ventricular ejection fraction, the time required for the heart rhythm to return to normal after aortic declamping, and the type of arrhythmia, did not show significant differences between the trial groups.
 
Conclusions: The findings of our trial demonstrated that, although there were no statistically significant changes in hemodynamic status, left ventricular ejection fraction, blood urea nitrogen, creatinine levels, inotropic score, time for heart rhythm resumption, and frequency of arrhythmia, reducing the interval between 2 Del Nido injections had positive effects on myocardial protection in pediatric heart surgeries. (Iranian Heart Journal 2025; 26(2): 6-14)
Keywords
Cardioplegia
Clinical outcome
Pediatric patients
Tetralogy of Fallot
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Iranian Heart Journal
Volume 26, Issue 2
Spring 2025
Pages 6-14