Cardioplegia practices in pediatric cardiovascular surgery: Survey across Asia, Europe, and North America

Background: Cardioplegia and myocardial protection strategies continue to evolve, with wide variation in reported practices. However, there is no contemporary report of these practices in pediatrics. We conducted a survey of pediatric cardioplegia practice among major institutions across Asia, Europe, and North America. Methods: A survey was distributed to members of the Congenital Heart Surgeons Society, European Congenital Heart Surgeons Association, and Asian Association for Pediatric and Congenital Heart Surgery. Responses were collected from March to September 2024. Questions focused on cardioplegia type, delivery, adjunct protection, del Nido usage, and differences in practices based on patient age or complexity. Results: Complete responses were obtained from 71 surgeons and 7 perfusionists representing 70 institutions. Although the types of solutions used vary across Asia and Europe, >80% of North America respondents reported using del Nido. Cold cardioplegia (<10 °C) was the predominant strategy (92%; n = 72 of 78 respondents). The most frequent dosing was induction between 20 and 30 mL/kg (76%; n = 59) and redosing between 10 and 20 mL/kg (63%; n = 49), with a wide range of redose timing (10-120 minutes). Notably, 28% of respondents (n = 22) reported giving only single-dose cardioplegia, and 56% (n = 44) reported using topical cooling, with only 8% (n = 6) using "hot shot" cardioplegia. Among respondents using del Nido, 91% (n = 43 of 47) reported using it exclusively for all cases. Conclusions: Institutions in North America are using primarily del Nido, while heterogeneity remains in cardioplegia use across Asia and Europe. There also remains significant variation in practices, highlighting the need for clinical outcomes studies to determine an optimal cardioplegia strategy.