Limitation of vasodilation associated with warm heart operation by a “mini-cardioplegia” delivery technique

Menasché, Philippe; Fleury, Jean-Pierre; Veyssié, Line; Dref, Olivier Le; Touchot, B; Piwnica, A; Bloch, G

doi:10.1016/0003-4975(95)90033-0

Cited by 12 publications

(13 citation statements)

References 17 publications

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“…The observation of spontaneous heartbeat recovery at aortic unclamping was statistically different between all of the microplegia and diluted cardioplegic groups, excepting in one individual study 8 . This was also true in most of the subgroup analyses, with the notable exceptions of aortic valve surgery, retrograde delivery, and warm delivery.…”

Section: Discussionmentioning

confidence: 78%

“…The eleven studies 6,8‐11,13‐18 included in the analysis had an aggregate of 5684 participants, 2681 of whom were microplegia patients versus 3003 who received other types of cardioplegia. The characteristics of the included studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Prospectively randomizing patients to either treatment technique was performed in six of the studies. [8][9][10][11]15,16 As the sample sizes in these studies were generally smaller, this meant that only 4.7% of the 5798 participants were randomized.…”

Section: Limitationsmentioning

confidence: 99%

“…The main advantages reported here include less haemodilution, reduced myocardial oedema, and rapid recovery of ventricular function. [6][7][8] In addition, the intermittent dosing in microplegia could play a vital role in managing harmful inflammatory responses to global ischemia and regional reperfusion, whereas diluted cardioplegia could have less control in its single-dose modality. 1 Early clinical trials reported the use of less vasopressors 8 and better postoperative left ventricular function 9 with microplegia.…”

Section: Introductionmentioning

confidence: 99%

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Microplegia in cardiac surgery: Systematic review and meta‐analysis

et al. 2020

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Background Consensus on the optimum choice of cardioplegia remains elusive. One possibility that has been suggested to have beneficial properties is microplegia, a cardioplegia of reduced crystalloid volume. The aim of this meta‐analysis is to comprehensively investigate microplegia against a range of clinical outcomes. Methods To identify potential studies, systematic searches were carried out in four databases (eg, Pubmed, EMBASE). The search strategy included the key concepts of “microplegia” OR “mini‐cardioplegia” OR “miniplegia” AND “cardiac surgery.” This was followed by a meta‐analysis investigating: mortality, crystalloid volume; cardiopulmonary bypass time; cross‐clamp time; intra‐aortic balloon pump use; spontaneous heartbeat recovery; inotropic support; low cardiac output syndrome; myocardial infarction; acute renal failure; atrial fibrillation, reoperation for bleeding; creatine kinase myocardial band (CK‐MB); intensive care unit (ICU) time and hospital stay. Results Eleven studies comprising 5798 participants were analyzed. Microplegia used a lower volume of crystalloids and led to a higher spontaneous return of heartbeat, odds ratio (OR) 4.271 (95% confidence intervals [CIs]: 1.935, 9.423; I2 = 76.57%; P < .001) and a lower requirement for inotropic support, OR: 0.665 (95% CI: 0.47, 0.941; I2 = 3.53%; P = .021). Microplegia was also associated with a lower CK‐MB release, mean difference (MD) −6.448 ng/mL (95% CI: −9.386, −3.511; I2 = 0%; P < .001) and a shorter ICU stay, MD: −0.411 days (95% CI: −0.812, −0.009; I2 = 17.65%; P = .045). All other comparisons were nonsignificant. Conclusions Microplegia has similar effects to other types of cardioplegia and is beneficial with regard to spontaneous return of heartbeat, inotropic support, ICU stay, and CK‐MB release.

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Section: Discussionmentioning

confidence: 78%

Section: Resultsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Microplegia in cardiac surgery: Systematic review and meta‐analysis

et al. 2020

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“…14,15 The minimal dilution technique is thought to increase the oxygen-carrying capacity during cardioplegia administration and reduce hemodilutioninduced deleterious effects on myocardial protection. [12][13][14][15] Furthermore, Hayashida et al demonstrated that minimallydiluted BCP protects the myocardium in association with preservation of myocardial metabolic activity after ischemia -reperfusion. 16 In fact, minimally-diluted BCP has been used for intraoperative myocardial protection.…”

mentioning

confidence: 99%