LAUSR

This study aimed to determine optimal techniques for reducing ischemic reperfusion injury (IRI) associated with cardiopulmonary bypass (CPB) in Libyan hospitals, providing insights to improve patient outcomes during cardiac surgeries. A systematic review of clinical trials from PubMed (2010–2024) was conducted, comparing five main types of cardioplegia: Del Nido cardioplegia (DNC), cold blood cardioplegia (CBC), warm blood cardioplegia (WBC), St. Thomas’ (STC), and Bretschneider / histidine-tryptophan-ketoglutarate (HTK) / Custodial cardioplegia. Additionally, a survey was administered to 30 experienced cardiac surgeons in Libyan hospitals to assess their preferences and practices regarding cardioplegia use. The systematic review analysed 22 clinical trials involving 7,693 patients: 1,174 received DNC, 774 received CBC, 302 received WBC, 5,246 received STC, and 197 received HTK. DNC was studied in 12 trials, CBC in 10, WBC in 4, STC in 4, and HTK in 6. DNC effectively reduced CPB time, cardioplegia volume, and postoperative complications. Survey results indicated a preference for DNC, with hypothermic and antegrade delivery commonly used. Although most surgeons perceived a low risk of IRI, some cases of IRI were reported, emphasizing the need for standardized protocols. DNC demonstrates strong potential as an optimal myocardial protective solution in Libyan hospitals. The adoption of standardized practices shows progress toward better outcomes, though further research and protocol refinements are essential to minimize IRI.