Supplemental Cardioplegia During Donor Heart Implantation: A Systematic Review and Meta-Analysis

Abstract

Background: The optimal donor heart preservation and management strategy during heart transplantation remains controversial. We report the results of a systematic review and meta-analysis of the effect of supplemental cardioplegia administration during donor heart implant for transplantation.

Methods: We searched MEDLINE and Embase databases until February 2019 for studies comparing patients who received transplants with the donor heart given supplemental cardioplegia or not. Data were extracted by 2 independent investigators. The main outcomes were early morbidity and mortality.

Results: Included were 7 retrospective observational studies (4 comparing to historical controls) and 3 randomized controlled trials enrolling 1125 patients. Supplemental cardioplegia included crystalloid and blood cardioplegia given continuous retrograde or as terminal "hot shots." Supplemental cardioplegia was associated with improved early mortality (risk ratio [RR], 0.55; 95% confidence interval [CI], 0.35-0.87; P < .01), greater rates of spontaneous return of sinus rhythm (RR, 2.62; 95% CI, 1.50-4.56; P < .01), shorter intensive care stay (mean difference, -3.4 days; 95% CI, -5.1 to -1.6; P < .01), and lower incidence of ischemic changes seen on endomyocardial biopsy specimens (RR, 0.49; 95% CI, 0.35-0.69; P < .01) compared with controls. Midterm mortality was not different between groups (incident rate ratio, 0.80; 95% CI, 0.51-1.26; P = .34).

Conclusions: Administration of supplemental cardioplegia may be associated with a reduction in organ ischemic injury and shorter intensive care stay as well as improvement in early survival after transplantation. This strategy may be a simple and cost-effective adjunct to improve outcomes of heart transplantation, especially in an era of increasing use of marginal donor organs. Further investigation will be needed to confirm the findings of this hypothesis-generating study.