title: Is microplegia really superior to standard blood cardioplegia? The results from a meta-analysis.
abstract: 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.
authors.affiliation: State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: B
authors.initials: B
authors.lastname: Gong
authors.affiliation: State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China dr.ji.cpb@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Ji
authors.affiliation: State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Sun
authors.affiliation: State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China Department of Anesthesia, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: G
authors.initials: G
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Zheng
mesh_terms: D002986:Clinical Trials as Topic; D006324:Heart Arrest, Induced / Q000009:adverse effects* / Q000379:methods*; D006438:Hemodilution / Q000009:adverse effects; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*
keywords: cardiac function; coronary artery bypass grafting; microplegia; myocardial protection; standard blood cardioplegia