A nation-wide survey of myocardial protection in cardiovascular surgery

A nationwide questionnaire survey was conducted by the Research and Education Committee of the Japanese Association for Thoracic Surgery to investigate current practices of myocardial protection using cardioplegia (CP) in cardiovascular surgery, with the aim of developing a recommendation statement on CP.

The survey was sent to 521 facilities and focused on adult cardiac surgery (ACS), aortic surgery (AS), and pediatric cardiac surgery (PCS). The response rate was 86.0%, with 448 institutions participating.

Among the participating hospitals, 64.3% used blood CP (BCP), 22.5% crystalloid CP (CCP), and 13.2% a combination of both. In CCP, the most common base solution was Miotector®, an extracellular fluid. In approximately half of the cases where CCP was used initially, BCP was employed for subsequent infusions. In BCP, a customized or modified version of Miotector® was also used as the base solution in over 50% of the cases. The ratio of blood to crystalloid solutions varied across institutions. For both forms of CP, the initial infusion volumes were typically around 20 ml/kg, with subsequent infusions averaging 10 ml/kg. A combined antegrade and retrograde CP infusion method was preferred by most institutions, and terminal warm CP was used in approximately 75% of institutions. Notably, the CP techniques used in minimally invasive cardiac surgery were consistent with those used in conventional surgery via median sternotomy.

This survey provides valuable insights into the diverse practices of myocardial protection, highlighting the need for further comprehensive studies to develop standardized guidelines for CP in cardiovascular surgery.