Table 3.

Clinical studies in pediatric surgery in which markers of myocardial injury were monitored.

Surgical Procedure	Patients Age	Applied Cardioplegia	Dosage and Administration	Temperature	Patients Per Group	Parameters of MI Assessment	Conclusion. Study/Year
Open cardiac surgery	1–120 months	STH I	Anterograde administrations of 25 mL/kg/min for 4 min	4–6 °C	27 infants	cTnI	STH cardioplegia is associated with MI, with more susceptibility to injury in infants than children. Immura H et al./2001 [55]
					31 ≥ 12 months
Elective ventricular septal defect repair in children	3–48 months	STH I crystalloid cardioplegia	Anterograde administrations of 25 mL/kg for 4 min, followed by a 2 min repeated dose of 15 mL/kg at 20 to 30 min intervals	4–6 °C	21	cTnI	Blood cardioplegia exerted more beneficial effects in heart preservation and significantly attenuated metabolic stress in ischemic conditions. Caputo M et al./2002 [58]
		4:1 dilution blood/STH I crystalloid cardioplegia			19
Cardiac surgery	4.5–98 months	STH I crystalloid cardioplegia	Anterograde administrations of induction dose of 110 mL/m2/min for 4 min and maintenance dose of 110 mL/m2/min for 2 min at 20 to 30 min intervals	4 °C	32	cTnI	Cold blood with warm blood cardioplegic solution was the optimal approach for cyanotic patients. Modi P et al./2004 [59]
		4:1 dilution blood/STH I crystalloid cardioplegia		4 °C	36
		Cold blood cardioplegia with terminal warm blood cardioplegic reperfusion	Induction and maintenance doses were the same during aorta cross-clamping, and then, the same dose was administered for 2 min at 37 °C immediately before unclamping	4 °C and terminal reperfusion at 37 °C	35
AV septal defects repair surgery	0–1 year	Plegisol	Anterograde administrations of 20 mL/kg; 10 mL/kg every 20–30 min	4 °C	15 15	CK-MB	Blood cardioplegia preserved myocardial function more effectively than crystalloid. Åmark Ket al/2005 [61]
		4:1 crystalloid/blood
Arterial switch operation	<30 days	Intermittent warm blood cardioplegia	1–1.5 times the physiological coronary flow rate infused anterogradely for 1 min every 10 min	35–36 °C	188	cTn-I	Better myocardial protection was achieved with repeated oxygenated WBC. Bojan M et al./2013 [65]
		Custodiol	30 mL/min for 7 min	4 °C	30
Arterial switch operation	<30 days	Blood cardioplegia	5 mL/kg/min, initially for 3 min through ascending aorta and repeated after 20 min	28 °C	44	cTn-I, CK-MB, BNP	Similar extent of myocardial damage and postoperative outcome. Giordano R et al./2016 [67]
		Custodiol	1 mL/min/g of heart weight	5–8 °C	50
Elective repair of ventricular septal defects and tetralogy of Fallot	≤12 years	4:1 dilution blood/STH I crystalloid cardioplegia	30 mL/kg initially, followed by repeated doses of 15 mL/kg at 25 to 30 min intervals	4 °C	50	cTn-I	del Nido solution exerted more beneficial effects in terms of preservation of cardiac structure, decrease in cTn-I release, and reduced morbidity. Talwar S et al./2017 [68]
		del Nido cardioplegia solution	20 mL/kg single dose was administered through the aortic root		50
Corrective cardiac surgery	3–69 months	Conventional blood cardioplegia	30 mL/kg dose was repeated beyond an ischemic time of 90 min for del Nido solution. Additionally, the dose was repeated after 20 min for blood cardioplegia	8–12 ° C	30	cTn-I, CK-MB	Both forms of cardioplegia were associated with similar time-related changes in cTn-I and CK-MB, thus suggesting similar myocardial protection. The advantages of del Nido solution involved decreased necessity for inotropic myocardial support and faster recovery of the heart rhythm. Panigrahi D et al./2018 [69]
		del Nido cardioplegia solution			30
Tetralogy of Fallot	0–18 years	Standard blood cardioplegia	Anterograde administrations of 20 mL/kg, every 20 min, repeated dose of 10 mL/kg	8–12 °C	26	CK-MB	Similar troponin T release was noticed in both groups, thus suggesting myocardial protection was achieved after blood and del Nido cardioplegic solutions. Negi SL et al./2019 [73]
		del Nido cardioplegia solution	20 mL/kg and subsequent dose if cross-clamp time exceeded 75 min	4–8 °C	30
Surgical repair of congenital heart disease	1–120 months	Blood cardioplegia	30 mL/kg every 4 min	4–6 °C	40	cTn-I	dN cardioplegia enables shorter aortic cross-clamp time and leads to a reduced level of cTn-I. Isildak FU et al./2021 [74]
		del Nido cardioplegia solution	20 mL/kg anterogradely, repeated dose for a procedure longer than 60–90 min		40
Correction of tetralogy of Fallot	8.3–16.4 months	Modified STH solution	Initially, 30 mL/kg anterogradely and every 40 min at 10 mL/kg	30 °C	27	cTn-I	cTn-I levels were elevated; nevertheless, no significant difference was observed between groups. Gorjipour F et al./2017 [76]
		del Nido cardioplegia solution	Initially, 20 mL/kg and subsequently, 10 mL/kg after 90 min		32