Myocardial protection for acquired heart disease surgery: results of a national survey.
To study current myocardial protection practices, all 4,393 United States board-certified thoracic surgeons were surveyed in 1992. Of the 1,413 respondents (32% total response), 936 are in active practice dealing with acquired heart disease. Based on their frequency of cases, respondents perform approximately 32% of all acquired heart disease operations in the United States yearly and individually average 157 patients/year. For myocardial protection, 98% of respondents routinely use cardioplegic arrest. The primary method of cardioplegia delivery is antegrade 36%, retrograde 4%, and a combination of antegrade and retrograde 60%. The types of cardioplegic solutions used are blood 72%, crystalloid 22%, and oxygenated crystalloid 6%. Continuous warm blood cardioplegia is used by 10% of respondents, whereas most (75%) have adopted a skeptical "wait and see" attitude or have abandoned it (6%). Overall, most surgeons (78%) report that they are very satisfied with their present methods of myocardial protection, whereas only 2% are dissatisfied. Still, the three areas believed most important for future research are reperfusion injury (74%), acutely infarcting myocardium (61%), and metabolic enhancers in cardioplegia (58%).
Robinson
L A
LA
Section of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha.
Schwarz
G D
GD
Goddard
D B
DB
Fleming
W H
WH
Galbraith
T A
TA
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002314:Cardioplegic Solutions; D003625:Data Collection; D006324:Heart Arrest, Induced / Q000706:statistics & numerical data*; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D014481:United States
D002314:Cardioplegic Solutions