Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Ann Thorac Surg. 2013 Sep;96(3):923-9. doi: 10.1016/j.athoracsur.2013.05.052. Epub 2013 Jul 31.
There are a wide variety of reported techniques with few comparative trials and no current data available by which surgeons can compare their myopreservation strategies across the specialty. We therefore surveyed congenital heart surgeons to develop a profile of current practice.
One hundred twenty-two members of the Congenital Heart Surgeons' Society were surveyed, and 56 responses were analyzed. The survey focused on cardioplegia formulations, dosage and administration, and perfusion strategies for four age groups: neonates, infants, children, and adolescents. All percentages are expressed as percentage of the entire reporting cohort (n=56).
Eighty-six percent of surgeons use blood-based cardioplegia versus crystalloid cardioplegia. Microplegia is used in 5%. Blood-based cardioplegia additives include del Nido (38%), customized solutions (32%), St. Thomas, Plegisol, or Baxter (11%), and microplegia (5%). Crystalloid cardioplegia types are Custodiol (7%), St. Thomas, Plegisol, or Baxter (5%), and customized solutions (2%). Cold (<10°C) cardioplegia is most common (93%), and "hot shots" are used in 21%. Moderate (26° to 30°C) hypothermic cardiopulmonary bypass is more common in neonates and infants compared with older children and adolescents. Antegrade administration is most common (89%). Longer intervals between cardioplegia doses were associated with surgeons using del Nido and Custodiol solutions, and these solutions were commonly administered with a single dose regardless of aortic cross-clamp time.
Myocardial protection techniques still remained highly variable among congenital heart surgeons. This survey demonstrates that there is a perception that del Nido and Custodiol solutions can offer appropriate myocardial protection for longer intervals with decreased repeat dosing. An observational study correlating markers of postoperative myocardial performance with myocardial preservation strategies should be considered.
有各种各样的报道技术，比较试验很少，目前没有可用的数据，外科医生可以在整个专业范围内比较他们的近视保留策略。因此，我们调查了先天性心脏病外科医生，以了解他们目前的实践情况。
对先天性心脏病外科医生协会的 122 名成员进行了调查，分析了 56 份回复。该调查侧重于四个年龄组（新生儿、婴儿、儿童和青少年）的心脏停搏液配方、剂量和管理以及灌注策略：新生儿、婴儿、儿童和青少年。所有百分比均表示为整个报告队列（n=56）的百分比。
86%的外科医生使用基于血液的心脏停搏液而不是晶体心脏停搏液。微麻痹的使用率为 5%。基于血液的心脏停搏液添加剂包括 del Nido（38%）、定制溶液（32%）、圣托马斯、普利戈索尔或百特（11%）和微麻痹（5%）。晶体心脏停搏液类型为 Custodiol（7%）、圣托马斯、普利戈索尔或百特（5%）和定制溶液（2%）。低温（<10°C）心脏停搏液最常见（93%），“热弹”使用率为 21%。与年龄较大的儿童和青少年相比，中低温（26°至 30°C）低温体外循环在新生儿和婴儿中更为常见。顺行给药最常见（89%）。心脏停搏液剂量之间的间隔时间较长与使用 del Nido 和 Custodiol 溶液的外科医生有关，并且这些溶液通常与单次剂量一起使用，而不管主动脉阻断时间如何。
心肌保护技术在先天性心脏病外科医生中仍然存在很大差异。这项调查表明，人们认为 del Nido 和 Custodiol 溶液可以在更长的时间间隔内提供适当的心肌保护，减少重复给药。应该考虑进行一项观察性研究，将术后心肌功能标志物与心肌保护策略相关联。
