L-Carnitine for Children Undergoing Open Cardiac Surgery for Congenital Heart Disease: A retrospective Study

Abstract

Background and aim: Cardiac surgery in pediatrics is associated with myocardial injury with potential increase of morbidity and mortality. Methods to protect against this injury are of crucial importance. L-carnitine seems to have a potential protective effects. However, this needs further confirmation and elucidation of possible mechanisms.  This study was designed to investigate the potential protective effects of L-carnitine on the cardiac injury after open heart surgery in pediatrics.

Patients and Methods: This was a multicenter retrospective study. It included 100 children, age 2-5 years, divided into two equal groups.  The first group included 50 children who received L-carnitine 50 mg/kg/day in a single daily dose for at least two weeks before cardiac surgery. The second group included 50 children matched for age and sex with the study group who were not used L-carnitine before surgery. The collected data include patient demographics, type of congenital heart defect, laboratory data (indicators of cardiac injury, oxidative stress markers and apoptosis marker caspase-3). Laboratory workup was repeated at the end of the first postoperative day.  Operative data and postoperative morbidity and in-hospital mortality were recorded.

Results: Both study and control groups were comparable regarding patient demographics and preoperative data. Males represented 56% and 60.0% of study and control groups, respectively. Atrial septal defect (ASD) and ventricular septal defect (VSD) were reported in 40% and 60% respectively with no significant differences between groups.  Postoperatively, cardiac Troponin-I, CK-MB, MDA, and Caspase-3 were significantly lower in study than control groups (0.52±0.089, 26.22±3.84, and 0.43±0.037 vs 1.62±0.38, 41.46±5.71 and 5.49±0.25, successively). However, SOD, and left ventricle EF% were significantly higher in the study than in the control group (3.86±0.47 and 62.06±1.89 vs 3.17±0.33 and 56.82±1.22, respectively). The need for inotropic drugs, development of arrhythmias was lower in the study then the control group. But the difference did not reach statistical significance. No in-hospital mortality was recorded. In control group, ejection fraction was significantly reduced after than before surgery (56.82±1.22 vs 62.20±2.59 respectively). However, in study group, this difference was non-significant.

Conclusion: Preoperative administration of L-carnitine for at least 2 weeks before open heart surgery was associated with a potential protective effect against cardiac injury induced by surgery in pediatrics.