Cardioprotection: A Review of Current Practice in Global Ischemia and Future Translational Perspective

Table 3

Best evidence papers.

Authors	Title	Year	Intervention	Patients included	Study design	Study endpoints	Reference
Øvrum et al.	A prospective randomized study of 1440 patients undergoing coronary artery bypass grafting	2004	Blood versus crystalloid	1.440*	Prospective randomized	Operative variables^1, inotropic support, ICU/hospital stay, arrhythmias, stroke, mortality	[11]
Ovrum et al.	A prospective randomised study of 345 aortic valve patients	2010		345*	Prospective randomised		[12]
Guru et al.	Is blood superior to crystalloid cardioplegia? A meta-analysis of randomized clinical trials	2006		5.044*	Meta-analysis	LOS, MI, CKMB at 7 h, 24 h, 48 h	[13]
Vhsilta et al.	Cardiomyocyte apoptosis after antegrade and retrograde cardioplegia during aortic valve surgery	2011	Antegrade versus retrograde	20*	Prospective randomised	Cardiomyocyte apoptosis (TUNEL assay, caspase 3, BCL-2, and BAX via ventricular biopsies upon reperfusion) ECHO	[19]
Lotto et al.	Myocardial protection with intermittent cold blood during aortic valve operation: antegrade versus retrograde delivery	2003		39*	Prospective randomised	Biopsies 20 min after cross-clamp removal, adenine nucleotide metabolites, lactate, troponin I	[20]
Radmehr et al.	Does combined antegrade-retrograde cardioplegia have any superiority over antegrade cardioplegia?	2008	Antegrade plus retrograde	87*	Prospective randomised	Inotropic support morbidity, ICU/hospital stay, mortality	[21]
Fan et al.	Does combined antegrade-retrograde cardioplegia have any superiority over antegrade cardioplegia?	2010	Warm versus cold	5.879*	Meta-analysis	LOS, inotropic support, MI, stroke, arrhythmias, cardiac index, Troponin, CKMB	[22]
Mallidi et al.	The short-term and long-term effects of cold or tepid cardiopelgia	2003		6.064*	Prospective cohort	MI, Mortality	[23]
Caputo et al.	Warm blood hyperkalaemic reperfusion (hot shot) prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery	1998	Cold-cold plus hot-shot	35*	Prospective randomised	Adenine nucleotide metabolites, alanine-glutamate ratio, lactate, troponin I: 5 min after begin of bypass, 30 min after arrest and 20 min after reperfusion	[25]

LOS, low output syndrome (requiring intotropic and/or intra-aortic balloon pump support); MI, myocardial infarction; CKMB, creatinine kinase MB; BCL-2, B-cell lymphoma 2 (antiapoptotic) and BAX protein (proapoptotic). ¹Operative variables include amount of cardioplegia used, spontaneous sinus rhythm after declamping, atrioventricular block, fluid excess. *7 prospective randomized studies as well as 2 large meta-analyses yielded a total number of 17.513 patients. The meta-analysis performed by Guru et al. [13] included the initial Ovrum et al. [12] study and those patients were thus subtracted.