Myocardial Protection With Different Cardioplegia in Adult Cardiac Surgery: A Network Meta-Analysis

Abstract

Cardioplegia is one of the most studied fields of myocardial protection during cardiac surgery. However, the most effective cardioplegia for protection in adult cardiac surgery remains unknown. PubMed and other databases were searched and a network meta-analysis with a Bayesian framework was performed. The primary outcomes were the serum concentrations of creatine kinase-myocardial band (CK-MB), cardiac troponin I, and cardiac troponin T (cTnT) at four time points. Several clinical outcomes were evaluated, including low output syndrome, myocardial infarction, and risk of early mortality. All studies that involved crystalloid cardioplegia without reference to St Thomas cardioplegia or histidine-tryptophan-ketoglutarate solution, and if the cardioplegia was used at a temperature between 4°C and 16°C were classified as cold crystalloid (cCCP) or cold blood cBCP cardioplegia. Warm blood cardioplegia (wBCP) was defined as the blood cardioplegia used at a temperature between 32°C and 37°C. Forty-seven (47) studies with a total of 4,175 patients were included. Seven (7) cardioplegia solutions were used, including cold CCP or BCP, del Nido solution, histidine-tryptophan-ketoglutarate solution, St Thomas cardioplegia, wBCP and warm terminal blood cardioplegia (wtBCP).Theserum concentrations of CK-MB at 2 hours (mean difference [MD], 213.56; 95% confidence interval [CI],-25.79 to-1.59) and cTnT at 24 hours of wBCP (MD,-1.50; 95% CI,-2.69 to-0.31) were significantly lower than that of cCCP. There were no significant differences in other outcomes of these six cardioplegia solutions, when compared to cCCP. The seven cardioplegia solutions analysed had similar myocardial protective effects after adult cardiac surgery, although wBCP had a lower CK-MB at 2 hours and lower cTnT at 24 hours.