CONCLUSION
In this single-centre trial of myocardial protection with St Thomas’ solution and normothermic bypass, IWBC is a safe and reproducible technique, but it does not provide superior myocardial protection to ICBC. Whether IWBC is advantageous for the most complex patients is uncertain as they are not represented in sufficient numbers. Thermic-3 adds to the paediatric cardiac surgery evidence base and assists us in our choices of bypass and cardioplegia strategies. It remains important for surgeons to overcome difficulties related to generating high-quality randomized evidence.