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Cardioplegia in paediatric cardiac surgery: a systematic review of randomized controlled trials

Nigel E Drury1,2, Ivan Yim1, Akshay J Patel1

  • 1Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK.

Interactive Cardiovascular and Thoracic Surgery
|June 28, 2018
PubMed

Insights

This systematic review found limited evidence on cardioplegia for myocardial protection in pediatric cardiac surgery due to small, low-quality trials. Developing a core outcome set is crucial for future high-quality research in pediatric cardioplegia.

Area of Science:

  • Pediatric Cardiac Surgery
  • Cardiovascular Research
  • Evidence-Based Medicine

Background:

  • Cardioplegia is essential for protecting the heart muscle during cardiac surgery.
  • Evaluating the existing evidence on cardioplegia in pediatric patients is critical for improving surgical outcomes.
  • A systematic review was conducted to assess the quality and scope of randomized controlled trials (RCTs) concerning cardioplegia in children.

Purpose of the Study:

  • To systematically review and evaluate the current evidence base of randomized controlled trials (RCTs) on cardioplegia for myocardial protection in pediatric cardiac surgery.
  • To identify the types of cardioplegia solutions and additives studied in children.
  • To assess the quality and limitations of existing research.

Main Methods:

  • A comprehensive search of MEDLINE, CENTRAL, and LILACS databases was performed.
  • Included were RCTs comparing cardioplegia solutions or additives in pediatric cardiac surgery patients; excluded were secondary publications and studies with inseparable adult data.
  • Data extraction and risk of bias assessment using the Cochrane Risk of Bias tool were conducted independently by at least two reviewers.

Main Results:

  • Twenty-six trials involving 1596 children were identified, all single-center Phase II trials with small patient numbers.
  • The most common comparisons involved blood versus crystalloid cardioplegia.
  • Frequent outcome measures included biomarkers of myocardial injury, inotrope requirements, and intensive care unit length of stay, but heterogeneity precluded meta-analysis.

Conclusions:

  • The current literature on pediatric cardioplegia lacks late-phase trials and is characterized by small sample sizes, inconsistent endpoints, and low methodological quality.
  • The limited evidence base necessitates the development of a core outcome set for standardized, validated endpoints.
  • High-quality, multicenter trials are needed to establish best practices for myocardial protection in pediatric cardiac surgery.
Abstract

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