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Is microplegia really superior to standard blood cardioplegia? The results from a meta-analysis
1State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Background:
Microplegia (whole blood cardioplegia with reduced volume) retains all the advantages of blood cardioplegia (such as superior oxygen-carrying capacity, better osmotic properties and antioxidant capability, etc.) without the potential disadvantages of hemodilution (such as myocardial edema). We sought to perform a systematic review and meta-analysis to compare microplegia and standard blood cardioplegia on the cardioprotective effects for patients undergoing coronary artery bypass grafting (CABG).
Methods:
MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched for relevant controlled trials published in English, from their inception up to May 15th, 2013. Data on low output syndrome, spontaneous return to sinus rhythm, volume of cardioplegia and perioperative myocardial infarction were analyzed.
Results:
Five studies, totaling 296 patients, were included out of 77 retrieved citations. The microplegia group used less volume of cardioplegia (WMD, -514.79 ml, 95%CI: -705.37 ml to -324.21 ml) when compared with the standard blood cardioplegia group. There were no statistical differences in the incidence of low output syndrome (RR, 0.95, 95%CI: 0.55 to 1.62), spontaneous return to sinus rhythm (RR, 1.64, 95%CI: 0.61 to 4.41) and perioperative myocardial infarction (RR, 0.62, 95%CI: 0.19 to 2.08).
Conclusions:
Microplegia was associated with less volume of cardioplegia, whereas the incidence of spontaneous return to sinus rhythm and perioperative myocardial infarction were similar, but large controlled randomized trials are still needed to confirm this.
Insights
Microplegia uses less cardioplegia volume compared to standard blood cardioplegia during coronary artery bypass grafting (CABG). Outcomes like low output syndrome and myocardial infarction were similar, but more research is needed.
Area of Science:
- Cardiovascular Surgery
- Cardioprotection
- Medical Technology
Background:
- Microplegia, a reduced-volume whole blood cardioplegia, offers advantages over standard blood cardioplegia.
- It aims to provide cardioprotection without the risks of hemodilution, such as myocardial edema.
- This approach is relevant for patients undergoing coronary artery bypass grafting (CABG).
Purpose of the Study:
- To systematically review and meta-analyze the cardioprotective effects of microplegia versus standard blood cardioplegia.
- To compare key clinical outcomes in patients undergoing CABG.
Main Methods:
- Systematic review and meta-analysis of controlled trials.
- Searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials up to May 2013.
- Analyzed data on low output syndrome, return to sinus rhythm, cardioplegia volume, and perioperative myocardial infarction.
Main Results:
- Five studies with 296 patients were included.
- Microplegia used significantly less cardioplegia volume (-514.79 ml).
- No significant differences were found in low output syndrome, spontaneous return to sinus rhythm, or perioperative myocardial infarction.
Conclusions:
- Microplegia is associated with reduced cardioplegia volume.
- Key clinical outcomes were comparable between microplegia and standard blood cardioplegia.
- Larger randomized controlled trials are recommended to validate these findings.
