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PROTECCION MIOCARDICA EN PEDIATRIA

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La cardioplejia es la mejor solución para obtener un campo operatorio cardíaco seco y quieto; también es el principal componente de la protección miocárdica.
durandy9_022813.jpg Autor:
Yves Durandy
Columnista Experto de SIIC

Institución:
Institut Hospitalier J. Cartier

Artículos publicados por Yves Durandy
Recepción del artículo
5 de Enero, 2013 		Aprobación
15 de Febrero, 2013
Primera edición
3 de Abril, 2013 		Segunda edición, ampliada y corregida
7 de Junio, 2021

PROTECCION MIOCARDICA EN PEDIATRIA

Resumen
La cardioplejia es la mejor solución para obtener un campo operatorio cardíaco seco y quieto; también es el principal componente de la protección miocárdica. No hay dudas de su eficiencia en la prevención de las lesiones isquémicas miocárdicas durante el clampaje transversal aórtico, aunque hay pocos datos, si los hay, basados en la evidencia sobre la mejor calidad y cantidad de la cardioplejia que se requiere para maximizar la protección miocárdica (la cual puede ser diferente de una patología a otra). Durante años el método de referencia fue la cardioplejia cristaloide fría intermitente, pero progresivamente se implementaron algunos perfeccionamientos. El cambio de una cardioplejia cristaloide a una sanguínea y de una fría a una templada fueron probablemente las dos modificaciones principales adoptadas por un gran número de cirujanos cardíacos. Estas modificaciones se implementaron inicialmente en la cirugía en adultos y luego se aplicaron en la cirugía pediátrica. El objetivo de esta reseña fue describir la base racional de estos cambios, así como la progresión del uso de la cardioplejia sanguínea templada intermitente en las unidades pediátricas, sus ventajas y resultados. Otros factores involucrados en la protección miocárdica y las perspectivas futuras se analizan brevemente.

Palabras clave
protección miocárdica, cardioplejia, cardioplejia sanguínea templada, cirugía con sangre templada


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Pediatric myocardial protection

Abstract
Cardioplegia is the best solution to obtain a dry and quiet operating field; it is also a major component of myocardial protection. There is no doubt about its efficiency in preventing myocardial ischemic injuries during aortic cross-clamping, however there are few if any evidence-based data on the best quality and quantity of cardioplegia needed to maximize myocardial protection (which is likely to be different from one pathology to another). For years the "gold standard" was crystalloid cold intermittent cardioplegia, but progressively some refinements were implemented. Shifts from crystalloid to blood and from cold to warm cardioplegia were probably the two major modifications adopted by a great number of cardiac surgeons. These modifications were initiated in adult surgery and then applied in pediatric surgery. The goal of this review is to describe the rationale for these changes as well as the progression of intermittent warm blood cardioplegia use in pediatric units, its advantages and its results. Others factors involved in myocardial protection and future perspectives are briefly discussed.

Key words
myocardial protection, cardioplegia, warm blood cardioplegia, warm surgery


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Especialidades
Principal: Cirugía, Pediatría
Relacionadas: Anestesiología, Cardiología, Cuidados Intensivos



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Yves Durandy, Institut Hospitalier J. Cartier, 91300, Avenue du Noyer Lambert, Massy, Francia
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