Evidence-based medicine and myocardial protection — where is the evidence?

Abstract

Uniform variables among different studies would be preferable for analysis of this topic; thus, it is the researchers' recommendation that the collection of multicenter data be undertaken in order to more fully answer this research question.Comparative effectiveness studies to associate commonly used solutions are needed. Without this research, surgeon preference remains the primary determining factor for deciding which cardioplegic solution to use. Cardioplegia selection should rely more on higher scientific research, using evidenced-based medicine and ranking of clinical studies.

Transitioning to Del Nido cardioplegia for all-comers: the next switching gear?

“…Cardioplegic arrest has been the preferred method of myocardial protection in most centers [2]. The ideal cardioplegia solution and administration regimen is still to be found [3].…”

“…In the last decade, Del Nido cardioplegia was gradually integrated into adult cardiac surgery surgical practice. Nevertheless, concerns were raised for use its use in the acquired cardiovascular disease population, partly because safety and efficacy data is missing [3]. So far, a number of small reports focused on a narrow portion of the practice and have been reassuring: 1) adult congenital [6], primary valve procedure [7][8][9][10][11], iterative valvular procedure [12], primary CABG [13][14][15], iterative CABG [16], and combined CABG and valvular procedures [17,18].…”

Myocardial protection in on-pump coronary artery bypass grafting surgery: analysis of the effectiveness of the use of retrograde Celsior®

“…Blood-based solutions are generally considered a more effective protection strategy, 12 but, on the other hand, single-dose crystalloid solutions could simplify the surgical procedure, as no interruptions are needed for the administration of repeated doses of cardioplegia. Over the years, several studies have been conducted comparing crystalloid and blood-based cardioplegic solutions, and most of the observational studies published up to date showed no significant differences in the clinical outcomes obtained with each alternative, 1 despite the fact that most of these studies did not include modern advanced-formulation crystalloid solutions, such as Custodiol®, Celsior® or Del Nido cardioplegia. 13 Although there is a general preference in the surgical community for blood-based cardioplegic solutions, 2 there are several studies that have supported the use of crystalloid solutions for myocardial protection in CABG.…”

“…The myocardial protection that we employed in the control group of our study, the infusion of continuous retrograde microplegia, 16 is one of the accepted alternatives of a blood-based solution for comparative studies when analyzing myocardial protection, 1 and there are several clinical studies endorsing its use. 8,[17][18][19][20] Moreover, it is considered as the myocardial protection strategy that adds less volume, and therefore, minimizes the risk of hemodilution during an on-pump procedure.…”

Lidocaine and Pinacidil Added to Blood versus Crystalloid Cardioplegic Solutions: Study in Isolated Hearts

“…Cardioplegic solution administration in open-heart surgeries has been the main strategy enable to antagonize the effects of global ischemia and reperfusion (IR). Cardioplegic arrest in combination with hypothermia corresponds to a standard method to reduce cardiac metabolism during the period of absence of oxygen and substrate, avoiding the collapse of contractile function after reperfusion [ 1 , 2 ] .…”