Comparative Effects of Del Nido, Blood Cardioplegia, Histidine-Tryptophan Ketoglutarate, and St. Thomas Cardioplegia Types in Cardiac Surgery: A Meta-Analysis
Research Article
DOI:
https://doi.org/10.5281/zenodo.8305513Keywords:
Cardiac surgery, Del Nido, Blood Cardioplegia, Histidine Tryptophan Ketoglutarate, St. Thomas, Heart protectionAbstract
The aim of this study is to compare the results of four types of cardioplegia during cardiac surgery: Del Nido (DN), blood cardioplegia, histidine-tryptophan ketoglutarate (HTK) and St Thomas. Randomized controlled trials (RCTs) and observational cohort studies from 2005 to 2021 were identified in the PubMed and Embase databases. Data were extracted for the primary endpoint of perioperative mortality, as well as the secondary endpoints of atrial fibrillation, renal failure, stroke, intra-aortic balloon pump use, revision, ICU stay, and hospital stay. A network meta-analysis was performed comparing all four cardioplegia types, as well as a direct meta-analysis comparing pairs of cardioplegia types. Data are from 18 RCTs and 49 observational cohort studies involving 18,191 adult patients (55 studies) and 1,634 children (12 studies). Among adult patients, the risk of mortality was significantly higher for HTC (HR 1.89, 95% CI 1.10, 3.52) and blood cardioplegia (RO 1.73, 95% CI 1.22, 2.79) relative to DN. The risk of atrial fibrillation was significantly higher for blood cardioplegia (RO 1.41, 95% CI 1.09, 1.86) and DN (RO 1.51, 95% CI 1.15, 2.03) compared to HTC. No significant difference in endpoints was observed between the four types of cardioplegia among pediatric patients. This network meta-analysis suggests that among adult patients undergoing cardiac surgery, DN may be associated with lower perioperative mortality than HTC or blood cardioplegia, while the risk of atrial fibrillation may be lower with HTC than with blood cardioplegia or DN.
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