EFFICACY OF A LOCALLY MODIFIED DEL NIDO CARDIOPLEGIC SOLUTION BASED ON NORMAL SALINE IN PEDIATRIC CARDIAC SURGERY

Effective myocardial protection remains a cornerstone of successful pediatric cardiac surgery. The choice of cardioplegia technique can significantly impact the extent of ischemia-reperfusion injury, particularly in young children with immature myocardium undergoing repair of congenital heart defects (CHDs). To compare the incidence of postoperative myocardial ischemic injury in children aged 1 to 3 years undergoing surgical correction of septal CHDs, based on the type of cardioplegic solution used: crystalloid versus blood-based modified del Nido solution. A prospective comparative study was conducted at the National Children’s Medical Center (Uzbekistan) from February 2021 to December 2024. Ninety-one patients with ASD or VSD were randomized into two groups: the control group (n = 44) received cold crystalloid cardioplegia, and the intervention group (n = 57) received a locally modified del Nido solution supplemented with oxygenated blood (4:1 ratio). The primary endpoint was defined as a >10-fold increase in troponin I levels at 6 hours postoperatively, persisting at 24 hours. Secondary outcomes included changes in left ventricular ejection fraction (LVEF) and inotropic support requirements. The incidence of the primary endpoint was significantly lower in the del Nido group (31.3%) compared to the crystalloid group (62.5%; p < 0.001). While troponin I levels decreased over time in both groups, LVEF declined more substantially in the crystalloid group (30.7% vs. 18% reduction at 24 hours postoperatively). Blood-based del Nido cardioplegia provided superior myocardial protection compared to crystalloid cardioplegia in young children undergoing open-heart repair of septal defects, as evidenced by lower biomarker elevation and better preservation of ventricular function.