Key result
Microplegia cuts cardioplegia volume by ~515 mL vs standard blood cardioplegia without reducing low output syndrome.
Why the study?
Microplegia retains advantages of blood cardioplegia without hemodilution disadvantages, but its cardioprotective effects compared to standard blood cardioplegia in CABG patients remain unclear.
Does microplegia improve cardioprotective effects compared to standard blood cardioplegia in patients undergoing CABG?
Meta-Analysis (n=296)
Does microplegia improve cardioprotective effects compared to standard blood cardioplegia in patients undergoing CABG?
Relative Risk: 0.95 (95% CI 0.55–1.62)
Microplegia reduces the volume of cardioplegia administered during CABG without significantly altering the rates of perioperative MI, low output syndrome, or spontaneous return to sinus rhythm compared to standard blood cardioplegia.
Microplegia reduces cardioplegia volume in CABG without increasing low-output syndrome risk; reinforces its role as a volume-sparing alternative.
BACKGROUND: Microplegia (whole blood cardioplegia with reduced volume) retains all the advantages of blood cardioplegia (such as superior oxygen-carrying capacity, better osmotic properties and antioxidant capability, etc.) without the potential disadvantages of hemodilution (such as myocardial edema). We sought to perform a systematic review and meta-analysis to compare microplegia and standard blood cardioplegia on the cardioprotective effects for patients undergoing coronary artery bypass grafting (CABG). METHODS: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched for relevant controlled trials published in English, from their inception up to May 15th, 2013. Data on low output syndrome, spontaneous return to sinus rhythm, volume of cardioplegia and perioperative myocardial infarction were analyzed. RESULTS: Five studies, totaling 296 patients, were included out of 77 retrieved citations. The microplegia group used less volume of cardioplegia (WMD, -514.79 ml, 95%CI: -705.37 ml to -324.21 ml) when compared with the standard blood cardioplegia group. There were no statistical differences in the incidence of low output syndrome (RR, 0.95, 95%CI: 0.55 to 1.62), spontaneous return to sinus rhythm (RR, 1.64, 95%CI: 0.61 to 4.41) and perioperative myocardial infarction (RR, 0.62, 95%CI: 0.19 to 2.08). CONCLUSIONS: Microplegia was associated with less volume of cardioplegia, whereas the incidence of spontaneous return to sinus rhythm and perioperative myocardial infarction were similar, but large controlled randomized trials are still needed to confirm this.
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Gong et al. (2014) conducted a meta-analysis in Coronary artery bypass grafting (CABG) (n=296). Microplegia vs. Standard blood cardioplegia was evaluated on low output syndrome (RR 0.95, 95% CI 0.55 to 1.62). Microplegia reduced the volume of cardioplegia used (WMD -514.79 ml; 95% CI -705.37 to -324.21) compared to standard blood cardioplegia, with no significant difference in low output syndrome (RR 0.95).