Is there any difference between blood and crystalloid cardioplegia for myocardial protection during cardiac surgery? A meta-analysis of 5576 patients from 36 randomized trials

Sá, Michel Pompeu Barros Oliveira; Rueda, Fábio Gonçalves de; Ferraz, Paulo Ernando; Chalegre, Sintya Tertuliano; Vasconcelos, Frederico Pires; Lima, Ricardo Carvalho

doi:10.1177/0267659112453754

Cited by 49 publications

(21 citation statements)

References 38 publications

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“…The concentrations are given for the ready-to-use mixture of blood and cardioplegia (Buckberg: blood:cardioplegia 4:1) skills, anesthesia regimen, catecholamines, anticoagulation, cardiopulmonary bypass strategy, severity of coronary artery disease), which leads to a limited effect of cardioplegia on these outcome parameters. This is visible in the fact that three meta-analyses containing up to 36 randomized studies and more than 5500 patients come to conflicting results regarding the efficacy of BCP and CCP on clinical endpoints [8][9][10]. The routine approach in our daily practice is to apply BCP for all adult cardiac surgery procedures.…”

Section: Discussionmentioning

confidence: 99%

“…It is usually applied as repeated infusions [7]. Both solutions have been tested experimentally and clinically, but the results even of meta-analyses are conflicting: Zeng et al 2014 [8] and Guru et al 2006 [9] showed superiority of BCP (lower myocardial infarction rate, lower rate of low output syndrome, and lower enzyme release), Sa et al 2012 [10] found no difference between BCP and CCP regarding risk of death, myocardial infarction, and low output syndrome. Likewise, experimental results have shown superiority of BCP [11][12][13][14][15] or of CCP [16].…”

Section: Introductionmentioning

confidence: 99%

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Cardiac surgery in acute myocardial infarction: crystalloid versus blood cardioplegia – an experimental study

Boening

Hinke

Heep

et al. 2020

J Cardiothorac Surg

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Background: Because hearts in acute myocardial infarction are often prone to ischemia-reperfusion damage during cardiac surgery, we investigated the influence of intracellular crystalloid cardioplegia solution (CCP) and extracellular blood cardioplegia solution (BCP) on cardiac function, metabolism, and infarct size in a rat heart model of myocardial infarction. Methods: Following euthanasia, the hearts of 50 rats were quickly excised, cannulated, and inserted into a blood-perfused isolated heart apparatus. A regional myocardial infarction was created in the infarction group (18 hearts) for 120 min; the control group (32 hearts) was not subjected to infarction. In each group, either Buckberg BCP or Bretschneider CCP was administered for an aortic clamping time of 90 min. Functional parameters were recorded during reperfusion: coronary blood flow, left ventricular developed pressure (LVDP) and contractility (dp/dt max). Infarct size was determined by planimetry. The results were compared between the groups using analysis of variance or parametric tests, as appropriate. Results: Cardiac function after acute myocardial infarction, 90 min of cardioplegic arrest, and 90 min of reperfusion was better preserved with Buckberg BCP than with Bretschneider CCP relative to baseline (BL) values (LVDP 54 ± 11% vs. 9 ± 2.9% [p = 0.0062]; dp/dt max. 73 ± 11% vs. 23 ± 2.7% [p = 0.0001]), whereas coronary flow was similarly impaired (BCP 55 ± 15%, CCP 63 ± 17% [p = 0.99]). The infarct in BCP-treated hearts was smaller (25% of myocardium) and limited to the area of coronary artery ligation, whereas in CCP hearts the infarct was larger (48% of myocardium; p = 0.029) and myocardial necrosis was distributed unevenly to the left ventricular wall. Conclusions: In a rat model of acute myocardial infarction followed by cardioplegic arrest, application of BCP leads to better myocardial recovery than CCP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiac surgery in acute myocardial infarction: crystalloid versus blood cardioplegia – an experimental study

Boening

Hinke

Heep

et al. 2020

J Cardiothorac Surg

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“…In another meta-analysis performed by Sa et al, they showed that there was no significant difference between patients using crystalloid cardioplegia solution and those with blood cardioplegia solution in terms of developing LCOS [26]. Increased CK-MB and troponin I values in the postoperative period estimate the myocardial damage in patients undergoing cardiac arrest with CPB [27].…”

Section: Discussionmentioning

confidence: 98%

Evaluation of the cardioprotective effects of crystalloid del Nido cardioplegia solution via a rapid and accurate cardiac marker: heart-type fatty acid-binding protein

Kirişçi¹,

Koçarslan²,

Aykan³

et al. 2020

Turk J Med Sci

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Background/aim: Our aim in this study was to compare the efficacy and safety of crystalloid del Nido solution and cold blood cardioplegia solution on clinical and laboratory parameters. Materials and methods: Sixty patients who underwent elective coronary bypass operation between July 2019 and January 2020 were included in our study. Patients were divided into 2 groups of 30 patients using del Nido solution (DNS) and cold blood cardioplegia solution (CBCS), which were given for cardiac arrest. Demographic data, preoperative, postoperative 0th h, 6th h and 4th day creatine kinase myocardial band (CK-MB) and troponin I values were compared with a specific cardiac enzyme heart-type fatty acid-binding protein (H-FABP). Results: We found that aortic cross clamp duration and cardiopulmonary bypass (CPB) time were shorter in patients using del Nido solution than cold blood cardioplegia solution (57.30 ± 23.57 min, 76.07 ± 27.18 min, P = 0.006) (95.07 ± 23.06 min, 114.13 ± 33.93, P = 0.014). Total cardioplegia solution volume was higher in the cold blood cardioplegia solution group (1426.67 ± 416.00 vs. 1200 ± 310.73 P = 0.02). Preoperative and postoperative levels of cardiac enzymes including CK-MB, troponin I and H-FABP were comparable in del Nido solution and cold blood cardioplegia solution groups. Conclusion: According to these results, when we compare both demographic data and CK-MB, troponin I and H-FABP levels, both cardioplegia solutions were comparable regarding safety and efficacy in terms of myocardial protection.

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“…Blood cardioplegia causes less hemodilution [3] and is also proven to be superior in inhibiting proteins responsible for ischemia-reperfusion-induced apoptosis [5]. Nonetheless some studies state that cold blood cardioplegia does not offer better myocardial protection than a cold crystalloid solution does [6]. Blood cardioplegia can also impair visualization and crystalloid cardioplegia is therefore still used by some surgeons, particularly in port-access and robotic surgery [3].…”

Section: Introductionmentioning

confidence: 99%

Myocardial Protection during Cardiac Surgery: Warm Blood versus Crystalloid Cardioplegia

Bruyn¹,

Gregoir²,

Waelbers³

et al. 2014

WJCD

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Purpose: Prevention of myocardial injury is essential during cardiac surgery. Both crystalloid and blood cardioplegia are popular methods for myocardial protection. Most experimental studies have been in favor of blood cardioplegia. The objective of this study is to determine whether the use of warm blood cardioplegia (BCP) is superior to crystalloid cardioplegia (CCP) by means of myocardial injury markers and clinical outcome parameters. Materials and Methods: In a consecutive series of 293 patients, the first 150 received crystalloid cardioplegia, whereas the next 143 patients received blood cardioplegia. Postoperative myocardial injury was assessed by CTnI and CK-MB. Perioperative morbidity and mortality and clinical outcome parameters (need for inotropic support, ICU and hospital stay) were recorded. An unpaired student t-test was performed to analyse continuous postoperative variables relating to myocardial damage. The presence of possible confounders influencing the CTnI or CK-MB concentrations was tested using a student t-test for continuous variables, for categorical variables ANOVA was used. A final longitudinal model was created for CTnI and CK-MB. CTnI was analyzed by a mixed model with random intercept and slope. For all tests performed, statistical significance was 5%. Results: Both groups were well matched with respect to preoperative variables. No significant difference could be found in maximum postoperative levels of CTnI (8.8 ± 18.4 µg/l in BCP vs 9.6 ± 16.5 µg/l in CCP, p = 0.6455) or CK-MB (19.2 ± 31.0 µg/l in BCP vs 26.4 ± 41.5 µg/l in CCP, p = 0.1209). Nor was there any significant difference in other postoperative variables. Testing treatment effect over time proved only significant influence of the surgical intervention type on CTnI levels in time (p < 0.001). Conclusion: This study could not show significantly higher myocardial injury in the group of patients re

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Is there any difference between blood and crystalloid cardioplegia for myocardial protection during cardiac surgery? A meta-analysis of 5576 patients from 36 randomized trials

Abstract: We found evidence that argues against any superiority in terms of hard outcomes between blood or crystalloid cardioplegia for myocardial protection during cardiac surgery.

Cited by 49 publications

References 38 publications

Cardiac surgery in acute myocardial infarction: crystalloid versus blood cardioplegia – an experimental study

Cardiac surgery in acute myocardial infarction: crystalloid versus blood cardioplegia – an experimental study

Evaluation of the cardioprotective effects of crystalloid del Nido cardioplegia solution via a rapid and accurate cardiac marker: heart-type fatty acid-binding protein

Myocardial Protection during Cardiac Surgery: Warm Blood versus Crystalloid Cardioplegia

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