Single- versus multidose cardioplegia in adult cardiac surgery patients: A meta-analysis

J Thorac Cardiovasc Surg. 2020 Nov;160(5):1195-1202.e12. doi: 10.1016/j.jtcvs.2019.07.109. Epub 2019 Sep 5.

Abstract

Objective: To compare outcomes of single (intervention group: del Nido [DN], and histamine-tryptophan-ketoglutarate) versus multidose (control group) cardioplegia in the adult cardiac surgery patients.

Methods: Medical search engines were interrogated to identify relevant randomized controlled trials and propensity-score matched cohorts. Meta-analysis was conducted for primary (in-hospital/30-day mortality) and secondary (ischemic and cardiopulmonary bypass [CPB] times, reperfusion fibrillation, peak of cardiac enzymes, myocardial infarction) endpoints. Subgroup analyses were conducted for study design and type of intervention, and meta-regression for primary outcome included type of surgery and left ventricular ejection fraction as moderators.

Results: Ten randomized controlled trials and 13 propensity-score matched cohorts were included, reporting on 5516 patients. Estimates are expressed as (parameter value [OR, odds ratio; MD, mean difference; SMD, standardized mean difference]/unit of measure [95% confidence interval], P value). DN reduced ischemic time (MD, -7.18 minutes [-12.52 to -1.84], P < .01), CPB time (MD, -10.44 minutes [-18.99 to -1.88], P .01), reperfusion fibrillation (OR, 0.16 [0.05-0.54], P < .01), and cardiac enzymes (SMD -0.17 [-0.29, 0.05], P < .01) compared with multidose cardioplegia. None of these beneficial effects were reproduced by histamine-tryptophan-ketoglutarate, which instead increased CPB time (MD, 2.04 minutes [0.73-3.37], P < .01) and reperfusion fibrillation (OR, 1.80 [1.20-2.70], P < .01). There was no difference in mortality and myocardial infarction between single and multidose, independently of type of surgery or left ventricular ejection fraction.

Conclusions: DN decreases operative times, reperfusion fibrillation, and surge of cardiac enzymes compared with multidose cardioplegia.

Keywords: HTK; cardiac protection; cardiac surgery; cardioplegia; coronary surgery; del Nido; minimally invasive surgery; valve surgery.

Publication types

  • Meta-Analysis

MeSH terms

  • Aged
  • Cardiac Surgical Procedures
  • Cardioplegic Solutions* / administration & dosage
  • Cardioplegic Solutions* / therapeutic use
  • Cardiopulmonary Bypass
  • Female
  • Heart Arrest, Induced* / methods
  • Heart Arrest, Induced* / mortality
  • Humans
  • Male
  • Middle Aged
  • Operative Time
  • Propensity Score
  • Randomized Controlled Trials as Topic

Substances

  • Cardioplegic Solutions