{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T12:02:56Z","timestamp":1784635376640,"version":"3.55.0"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["JRSM Cardiovascular Disease"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardioplegia remains a cornerstone of myocardial protection during cardiac surgery; however, the configuration of its delivery circuit, particularly priming volume and blood\u2013synthetic surface area, can exert a measurable influence on patient outcomes. Oversized or non-tailored circuits inherently increase hemodilution, inflammatory activation, and coagulation disturbances, effects that are especially pronounced in neonates and small children, whose circulating blood volume is limited. Advances in modular heart\u2013lung machine (HLM) technology have introduced the possibility of tailoring cardioplegia circuits to patient size and procedural requirements, aligning mechanical design with physiological principles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A narrative review was conducted using PubMed, Scopus, and Google Scholar for studies published between January 1976 and July 2025. Search terms included \u201ccardioplegia,\u201d \u201cmyocardial protection,\u201d \u201ccardioplegia circuit,\u201d \u201cpriming volume,\u201d \u201cmodular heart\u2013lung machine,\u201d \u201cmicroplegia,\u201d \u201cdel Nido cardioplegia,\u201d and related keywords. The search identified 286 records; after duplicate removal and eligibility screening, 22 studies were included in the final qualitative synthesis. Evidence was analyzed according to four domains: priming volume and blood conservation, contact surface area and inflammation, modularity and circuit customization, and physiological implications of delivery strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cardioplegia delivery circuit design appears to be a clinically relevant but underrecognized component of myocardial protection. Modular HLM platforms provide a practical approach to reduce circuit complexity and adapt extracorporeal circulation to individual patient requirements. Further prospective multicenter studies are needed to define the impact of modular cardioplegia circuits on clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Modular HLM technology provides a flexible and physiologically grounded platform for tailoring cardioplegia delivery to individual patient profiles. Standardizing weight-banded modular configurations and implementing routine monitoring of priming volume-to-weight ratios could improve consistency in practice and serve as a foundation for prospective studies. The cumulative evidence suggests that extending modular principles to the cardioplegia circuit represents an underutilized but promising opportunity to enhance both pediatric and adult cardiac surgical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20480040261472353","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T11:30:32Z","timestamp":1784633432000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tailoring cardioplegia delivery circuits with modular heart\u2013lung machines: A narrative review"],"prefix":"10.1177","volume":"15","author":[{"given":"Youssef","family":"El Dsouki","sequence":"first","affiliation":[{"name":"Maastricht University Medical Centre MUMC"},{"name":"Cardiovascular Research Centre Maastricht CARIM, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9824-733X","authenticated-orcid":false,"given":"Sibel","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Ko\u015fuyolu High Specialization Education and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanan Abdullah Mohammed","family":"Alanazi","sequence":"additional","affiliation":[{"name":"King Fahad Medical City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakaria","family":"El Koraychi","sequence":"additional","affiliation":[{"name":"C.I.R \u2013 Cura In Rete SRL, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopikrishnan","family":"Thalapathy","sequence":"additional","affiliation":[{"name":"Sheikh Khalifa Medical City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1192-1908","authenticated-orcid":false,"given":"Ignazio","family":"Condello","sequence":"additional","affiliation":[{"name":"University of Insubria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"98","article-title":"Myocardial protection: an overview","volume":"5","author":"Buckberg GD","year":"1993","unstructured":"Buckberg GD. Myocardial protection: an overview. Semin Thorac Cardiovasc Surg 1993; 5: 98\u2013106.","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)40006-8"},{"key":"e_1_3_2_4_2","first-page":"159","article-title":"Compact extracorporeal circulation: reducing the surface of cardiopulmonary bypass to improve outcomes","volume":"16","author":"Borrelli U","year":"2007","unstructured":"Borrelli U, Al-Attar N, Detroux M, et al. Compact extracorporeal circulation: reducing the surface of cardiopulmonary bypass to improve outcomes. 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