Kalp Cerrahisinde Del Nido, Kan Kardiyoplejisi, Histidin-Triptofan Ketoglutarat Ve St. Thomas Kardiyopleji Türlerinin Karşılaştırmalı Etkileri: Meta Analiz
Araştırma Makalesi
DOI:
https://doi.org/10.5281/zenodo.8305513Anahtar Kelimeler:
Kalp cerrahisi, Del Nido, Kan Kardiyoplejisi, Histidin-Triptofan Ketoglutarat, St. Thomas, Kalp korumaÖzet
Bu çalışmada amaç, kalp cerrahisi sırasında Del Nido (DN), kan kardiyoplejisi, histidin-triptofan ketoglutarat (HTK) ve St. Thomas olarak dört tip kardiyoplejinin sonuçlarını karşılaştırmaktır. 2005'ten 2021'e kadar randomize kontrollü çalışmalar (RKÇ) ve gözlemsel kohort çalışmaları PubMed ve Embase veritabanlarında belirlendi. Perioperatif mortalitenin birincil son noktasının yanı sıra atriyal fibrilasyon, böbrek yetmezliği, inme, intra aortik balon pompası kullanımı, revizyon, yoğun bakım ünitesinde kalış ve hastanede kalış olan ikincil son noktalar için veriler çıkarıldı. Dört kardiyopleji tipinin tümünü karşılaştıran bir ağ meta-analizi ve ayrıca kardiyopleji tipi çiftlerini karşılaştıran doğrudan meta-analiz yapıldı. Veriler, 18.191 yetişkin hastayı (55 çalışma) ve 1.634 çocuğu (12 çalışma) kapsayan 18 RKÇ ve 49 gözlemsel kohort çalışmasından elde edilmiştir. Yetişkin hastalar arasında mortalite riski HTK (RO 1.89, %95 GA 1.10, 3.52) ve kan kardiyoplejisi (RO 1.73, %95 GA 1.22, 2.79) için DN'ye göre anlamlı derecede yüksekti. Atriyal fibrilasyon riski, kan kardiyoplejisi (RO 1.41, %95 GA 1.09, 1.86) ve DN (RO 1.51, %95 GA 1.15, 2.03) için HTK'ya göre anlamlı derecede yüksekti. Pediatrik hastalar arasında dört kardiyopleji tipi arasında son noktalarda anlamlı bir fark gözlenmedi. Bu ağ meta-analizi, kalp ameliyatı geçiren yetişkin hastalar arasında DN'nin HTK veya kan kardiyoplejisine göre daha düşük perioperatif mortalite ile ilişkili olabileceğini, atriyal fibrilasyon riskinin ise HTK ile kan kardiyoplejisi veya DN'ye göre daha düşük olabileceğini düşündürmektedir.
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