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Cardioplegia Practices In Pediatric Cardiovascular Surgery
Robert X. Lao, Cristina Salvo, Osami Honjo.
The Hospital for Sick Children, Toronto, ON, Canada.
Objective(s): Cardioplegia and myocardial protection strategies in pediatric cardiovascular surgery continue to evolve and there has been wide variation in practice across North America. The most recent survey of practices was over a decade ago. We therefore conducted a survey to understand current myocardial protection practice among North American institutions.
Methods: An online survey was distributed to one hundred eighty-two surgeons from the Congenital Heart Surgeons’ Society and perfusionists across North America. We focused on cardioplegia composition and delivery, the use of adjunct myocardial protection strategies, the use or hesitancy regarding del Nido and whether practices differ with patient age and/or complexity.
Results: Responses were obtained from forty-seven surgeons and three perfusionists representing forty-two institutions. Sixty-six percent of respondents indicated that their institution has firm guidelines on cardioplegia practices. Majority of respondents use del Nido (78%), followed by Custodiol/HTK (14%), St. Thomas No.2/Plegisol (4%) or customized depolarizing solutions (4%). Cold cardioplegia (<10C) remains the most common strategy (92%) with fifty-eight percent of surgeons also using topical cooling. The most popular practice for del Nido is delivery at 1:4 blood-to-crystalloid ratio (66%), induction dose between 20-30mL/kg (74%) and re-doses between 10-20mL/kg (60%) with high variation in re-dose timing. Seventy-two percent of centres are exclusively using del Nido. More surgeons adjust practice based on complexity of repair (30%) versus age (8%).
Conclusions: There has been a clear shift across North America toward using del Nido cardioplegia. However, there remains significant heterogeneity highlighting a need for outcomes studies to determine optimal cardioplegia strategy.
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