Aim
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.
Method
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.
Results
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). The serum
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: September 30, 2021
Accepted:
September 7,
2021
Received in revised form:
August 5,
2021
Received:
March 8,
2021
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
