Preferred types of cardioplegia and their rationale in open-heart surgeries with prolonged anticipated cross-clamp times in cardiovascular surgery clinics in Turkey

Introduction: Solutions used to meet the metabolic needs of the heart tissue during open heart operations are called cardioplegia solutions. In routine operations, the cardioplegia solution is repeated every 15-20 minutes as long as the cross-clamp (the period during which the heart is stopped) continues. In line with studies conducted in recent years, many clinics prefer solutions that can protect the heart for longer periods such as Plegisol, Custadiol, and Del Nido Cardioplegia (DNC) in patients whose cross- clamp duration is expected to exceed 60 minutes. This study aims to examine the types of cardioplegia solutions preferred in open heart operations with long cross-clamp durations (>60 minutes) in cardiovascular surgery clinics in Turkey and the reasons for their preference. Material-Method: The necessary ethics committee permission for the study was obtained from the MCBU Faculty of Medicine Health Ethics Committee and planned prospectively. The study was conducted with a 22-question survey targeting perfusionists registered with the Turkish Perfusionists Association. The survey questioned which cardioplegia solutions are preferred in open heart operations requiring long-term cross-clamping and the advantages and disadvantages of these preferences. In addition, differences in preferences according to geographical regions were analyzed with the chi-square test. Findings-Discussion: As a result of our study, it was observed that DNK solution and its modifications are the most commonly used in open heart operations requiring long cross-clamping (>60 min) throughout Turkey. Blood-cardioplegia is the second most frequently used cardioplegic solution. According to the survey results directed to perfusionists, the reasons why clinics prefer DNK are that DNK solution is reliable and effective in myocardial protection. Perfusionists think that DNK shortens the operation and ischemia time because it protects the myocardium with a single bolus dose of DNK for up to 90 minutes, and since the operation is continued without pauses to administer cardioplegia during surgery, and they think that it is less costly. Conclusion and Recommendations: Our study has shown that DNK is the preferred choice in open heart operations where long cross-clamping times are anticipated in Turkey. However, the data reflect the views of perfusionists and common clinical practice. The superiority of cardioplegia types over each other should be compared with further randomized controlled prospective studies. In addition, our study will create a detailed data source on the types of cardioplegia and application methods preferred in cardiac surgery clinics in Turkey and will guide the planning of future publications.