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Updated: Sep 16, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Network meta-analysis of cardioplegic methods, in elective isolated coronary artery bypass grafting
Paris Dimitrios Kalogerakos1, Stamatios Kokkinakis2, Evangelos Akoumianakis3
1Department of Cardiac Surgery, General University Hospital of Heraklion, Crete, Greece.
Insights
Warm antegrade/retrograde blood cardioplegia may offer benefits for coronary artery bypass grafting patients, potentially reducing mortality and hospital stay. Further research is recommended due to study limitations.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- The optimal method for inducing cardioplegic arrest in cardiac surgery remains debated.
- Various cardioplegic solutions and delivery techniques exist, each with potential advantages and disadvantages.
Purpose of the Study:
- To compare the efficacy and safety of different cardioplegic methods in adult patients undergoing elective isolated coronary artery bypass grafting.
- To evaluate the impact of cardioplegia composition, delivery route, and temperature on clinical outcomes.
Main Methods:
- A network meta-analysis was conducted, synthesizing data from 75 randomized controlled trials involving 6131 patients.
- Included studies compared 13 distinct cardioplegic methods, analyzing variations in composition (crystalloid vs. blood), delivery (antegrade vs. retrograde), and temperature.
- Outcomes assessed included mortality, myocardial infarction, need for intra-aortic balloon pump, low cardiac output syndrome, and length of hospital stay.
Main Results:
- Warm antegrade/retrograde blood cardioplegia was associated with reduced mortality, fewer intra-aortic balloon pump insertions, and shorter intensive care and hospital stays.
- Crystalloid cardioplegias were linked to shorter cross-clamp times, while warm blood cardioplegias reduced reperfusion ventricular fibrillation.
- Cold cardioplegias demonstrated lower rates of new-onset atrial fibrillation and stroke, though confidence in findings varied across endpoints.
Conclusions:
- Warm antegrade/retrograde blood cardioplegia appears to offer potential advantages for patients undergoing elective isolated coronary artery bypass grafting.
- Results should be interpreted with caution due to identified biases and variable confidence levels across outcomes.
- Further research is warranted to definitively establish the superiority of specific cardioplegic strategies.
Abstract:
BackgroundCardioplegic arrest can be induced by various methods, fueling a long-standing controversy about their comparative merit. We aim to compare cardioplegic methods in coronary artery disease.MethodsPubMed, Embase, and Cochrane databases were interrogated for randomized trials that compared various cardioplegic methods in adult patients undergoing elective isolated coronary artery bypass grafting. Differences in cardioplegic composition - crystalloid or blood, route of delivery - antegrade or retrograde, and temperature, were evaluated in a network meta-analysis. The endpoints were mortality, myocardial infarction, insertion of intra-aortic balloon pump, low cardiac output syndrome, increased inotropic support, as well as cardiopulmonary bypass time, aortic cross-clamp time, intensive care stay, hospital stay, new onset atrial fibrillation, reperfusion ventricular fibrillation, and neurologic event. Confidence In Network Meta-Analysis web application was employed.Results75 studies were included, with 6131 patients receiving one of 13 cardioplegic methods. Warm ante/retrograde blood cardioplegia was associated with fewer deaths (P-score 0.81), fewer intra-aortic balloon pumps (P-score 0.77), and shorter intensive care (P-score 0.69) and hospital stay (P-score 0.81). Cross clamp time was shorter with crystalloid cardioplegias, while reperfusion ventricular fibrillation was less frequent with warm blood cardioplegias. Cold cardioplegias were associated with lower rates of new onset atrial fibrillation and stroke. Confidence varied greatly across the endpoints.ConclusionThe outcomes of this network study indicate presumable advantages of warm ante/retrograde blood cardioplegia in elective isolated coronary artery bypass grafting. Under the light of certain biases and mixed confidence, the results should be cautiously interpreted. More studies are needed.
