Abstract
Consensus on the optimum choice of cardioplegia remains elusive. One possibility that has been suggested to have beneficial properties is microplegia, a cardioplegia of reduced crystalloid volume. The aim of this meta-analysis is to comprehensively investigate microplegia against a range of clinical outcomes. To identify potential studies, systematic searches were carried out in four databases (eg, Pubmed, EMBASE). The search strategy included the key concepts of "microplegia" OR "mini-cardioplegia" OR "miniplegia" AND "cardiac surgery." This was followed by a meta-analysis investigating: mortality, crystalloid volume; cardiopulmonary bypass time; cross-clamp time; intra-aortic balloon pump use; spontaneous heartbeat recovery; inotropic support; low cardiac output syndrome; myocardial infarction; acute renal failure; atrial fibrillation, reoperation for bleeding; creatine kinase myocardial band (CK-MB); intensive care unit (ICU) time and hospital stay. Eleven studies comprising 5798 participants were analyzed. Microplegia used a lower volume of crystalloids and led to a higher spontaneous return of heartbeat, odds ratio (OR) 4.271 (95% confidence intervals [CIs]: 1.935, 9.423; I2 = 76.57%; P < .001) and a lower requirement for inotropic support, OR: 0.665 (95% CI: 0.47, 0.941; I2 = 3.53%; P = .021). Microplegia was also associated with a lower CK-MB release, mean difference (MD) -6.448 ng/mL (95% CI: -9.386, -3.511; I2 = 0%; P < .001) and a shorter ICU stay, MD: -0.411 days (95% CI: -0.812, -0.009; I2 = 17.65%; P = .045). All other comparisons were nonsignificant. Microplegia has similar effects to other types of cardioplegia and is beneficial with regard to spontaneous return of heartbeat, inotropic support, ICU stay, and CK-MB release.
Highlights
Consensus on the optimum choice of cardioplegia remains elusive
We found that microplegia used a lower crystalloid volume and was beneficial with respect to spontaneous heartbeat recovery, inotropic support, creatine kinase myocardial band (CK‐MB) release, and intensive care unit (ICU) stay time
All of the other comparisons including mortality were not statistically significant. This suggests that microplegia has similar effects compared to diluted cardioplegia and may have some benefits
Summary
Cardiopulmonary bypass (CPB) provides physiological support through an extracorporeal circuit, circumventing the heart, which is afforded a bloodless field by aortic cross‐clamp. The main advantages reported here include less haemodilution, reduced myocardial oedema, and rapid recovery of ventricular function.[6,7,8] In addition, the intermittent dosing in microplegia could play a vital role in managing harmful inflammatory responses to global ischemia and regional reperfusion, whereas diluted cardioplegia could have less control in its single‐dose modality.[1]. Data were extracted using predesigned extraction tables Included trials were those that directly compared the use of microplegia versus any other type of cardioplegia in open‐heart surgery. Other treatment modalities and interventions for coronary artery disease such as percutaneous coronary intervention and valvular disease such as transcatheter aortic valve intervention were excluded This meta‐analysis analysed randomized controlled trials (RCTs) and case‐control trials of both male and female adult (≥18 years) patients with coronary artery disease or valvular disease who were undergoing cardiac surgery using either microplegia or other types of cardioplegia. All RCTs and retrospective trials where the intervention of carrying out cardiac surgery using microplegia was performed
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