Microplegia vs 4:1 Blood Cardioplegia: Effectiveness and Cost Savings in Complex Cardiac Operations

Area of Science:

• Cardiovascular Surgery
• Cardioplegia Techniques
• Myocardial Protection

Background:

• Microplegia has been used in isolated surgeries but not extensively in complex cardiac procedures.
• The study addresses the gap in understanding microplegia's application in multicomponent operations.

Purpose of the Study:

• To evaluate the safety and effectiveness of simplified microplegia compared to Buckberg cardioplegia.
• To assess microplegia's utility in complex cardiac surgeries involving aortic and valve procedures.

Main Methods:

• A comparative study involving 242 patients receiving simplified microplegia and 10,512 patients receiving modified Buckberg cardioplegia.
• Propensity-matched analysis of 226 pairs to compare outcomes in complex multicomponent operations.
• Operations included aortic root, arch, or ascending aorta replacement, aortic valve surgery, and coronary artery bypass grafting.

Main Results:

• No significant difference in postoperative troponin T levels between groups after adjusting for aortic clamp time.
• Microplegia group showed significantly reduced crystalloid use (27 mL vs 735 mL) and lower peak intraoperative glucose.
• Similar rates of in-hospital mortality, stroke, renal failure, and prolonged ventilation were observed between the groups.

Conclusions:

• Simplified microplegia is a safe and effective alternative to Buckberg cardioplegia for complex cardiac surgeries.
• The technique offers advantages including reduced crystalloid administration and lower costs.
• Myocardial protection and patient safety were not compromised with the simplified microplegia approach.