Role of terminal warm blood cardioplegia in complex congenital heart surgery

Pribadi Wiranda Busro, Harvey Romolo, Sudigdo Sastroasmoro, Jusuf Rachmat, Mohamad Sadikin, Anwar Santoso, Cindy Elfira Boom, Suhendro, Ahmad Aulia

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Introduction: Myocardial protection is vital to ensure successful open heart surgery. Cardioplegic solution is one method to achieve good myocardial protection. Inevitably, ischemia-reperfusion injury occurs with aortic crossclamping. Histidine-tryptophan-ketoglutarate solution is a frequently used cardioplegia for complex congenital heart surgery. We postulated that addition of terminal warm blood cardioplegia before removal of the aortic crossclamp might improve myocardial protection. Method: A randomized controlled trial was conducted on 109 cyanotic patients aged, 1 to 5 years who underwent complex biventricular repair. They were divided into a control group of 55 patients who had histidine-tryptophan-ketoglutarate only and a treatment group of 54 who had histidine-tryptophan-ketoglutarate with terminal warm blood cardioplegia. Endpoints were clinical parameters, troponin I levels, and caspase-3 as an apoptosis marker. Results: The incidence of low cardiac output syndrome was 34%, with no significant difference between groups (35.2% vs. 33.3%, p = 0.84). The incidence of arrhythmias in our treatment group was lower compared to the control group (36% vs. 12%, p = 0.005). Troponin I and caspase-3 results did not show any significant differences between groups. For cases with Aristotle score ≥ 10, weak expression of caspase-3 in the treatment group post-cardiopulmonary bypass was lower compared to the control group. Conclusion: For complex congenital cardiac surgery, the addition of terminal warm blood cardioplegia does not significantly improve postoperative clinical or metabolic markers.

Original languageEnglish
Pages (from-to)196-202
Number of pages7
JournalAsian Cardiovascular and Thoracic Annals
Issue number3
Publication statusPublished - 1 Mar 2018


  • Cardioplegic solutions
  • Cardiopulmonary bypass
  • Caspase 3
  • Heart arrest
  • Heart defects
  • Myocardial reperfusion injury
  • congenital
  • induced


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