Yotsuida Hideki, Fujita Tomoyuki, Yamamoto Hiroshi, Ono Minoru, Motomura Noboru, Saito Aya, Hiramatsu Yuji, Fukuda Hirotsugu, Miyazaki Takako, Wada Yuko, Sawa Yoshiki, Ogino Hitoshi
Department of Clinical Engineering, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Department of Cardiovascular Surgery, Institute of Science Tokyo, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2025 May 27. doi: 10.1007/s11748-025-02161-y.
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.
日本胸外科学会研究与教育委员会开展了一项全国性问卷调查，以调查心血管手术中使用心脏停搏液（CP）进行心肌保护的当前做法，旨在制定一份关于CP的推荐声明。
该调查发送至521家机构，重点关注成人心脏手术（ACS）、主动脉手术（AS）和小儿心脏手术（PCS）。回复率为86.0%，有448家机构参与。
在参与调查的医院中，64.3%使用血液CP（BCP），22.5%使用晶体CP（CCP），13.2%使用两者的组合。在CCP中，最常用的基础溶液是细胞外液Miotector®。在最初使用CCP的病例中，约一半随后使用BCP进行输注。在BCP中，超过50%的病例也使用定制或改良版的Miotector®作为基础溶液。不同机构血液与晶体溶液的比例各不相同。对于两种形式的CP，初始输注量通常约为20 ml/kg，随后的输注平均为10 ml/kg。大多数机构更喜欢采用顺行和逆行CP联合输注方法，约75%的机构使用终末温血CP。值得注意的是，微创心脏手术中使用的CP技术与经正中胸骨切开的传统手术中使用的技术一致。
本次调查为心肌保护的多样做法提供了有价值的见解，突出了需要进一步开展全面研究以制定心血管手术中CP的标准化指南。
