Propofol-Supplemented Cardioplegic Solution Effect on Myocardial Protection: A Systematic Review and Bayesian Meta-analysis of Randomized Controlled Trials.

OBJECTIVES

To determine the probability of a clinically relevant reduction in postoperative myocardial injury following the use of propofol-supplemented cardioplegia.

DESIGN

Systematic review and Bayesian meta-analysis.

SETTING

Perioperative cardiac surgery.

PARTICIPANTS

Adult patients (N = 523) undergoing cardiac surgery requiring cardiopulmonary bypass.

INTERVENTIONS: Propofol-supplemented cardioplegic solution versus standard cardioplegia.

MEASUREMENTS AND MAIN

RESULTS

The primary endpoint was postoperative troponin levels. A Bayesian hierarchical random-effects model using weakly informative priors yielded a pooled standardized mean difference (SMD) of -0.05 (95% credible interval [CrI], -0.33 to 0.24). The posterior probability of any reduction in postoperative troponin levels (SMD < 0) was 70.8%. Secondary endpoints showed similarly uncertain evidence of benefit, including postoperative creatinine levels (SMD, -0.06; 95% CrI, -0.71 to 0.46; probability of benefit, 59.8%), serious complications (risk ratio [RR], 0.77; 95% CrI, 0.18 to 2.28; probability of benefit, 70.3%), and postoperative arrhythmias (RR, 0.96; 95% CrI, 0.51 to 1.62; probability of benefit, 56.4%).

CONCLUSIONS

Current evidence suggests moderate posterior probabilities of benefit across endpoints. However, substantial uncertainty remains regarding the magnitude and direction of the true treatment effects. These findings do not provide convincing evidence to support routine addition of propofol to standardized cardioplegic protocols, and the use of propofol-supplemented cardioplegia should remain at the discretion of the heart surgery team.