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Single- versus multidose cardioplegia in adult cardiac surgery patients: A meta-analysis
Ivancarmine Gambardella1, Mario F L Gaudino2, George A Antoniou3
1Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Medical Center, New York, NY; Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
Insights
Del Nido cardioplegia significantly reduces operative times and improves outcomes like reperfusion fibrillation and cardiac enzyme levels compared to multidose cardioplegia in adult cardiac surgery. This single-dose approach offers a beneficial alternative for cardiac procedures.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia Solutions
Background:
- Cardioplegia is crucial for myocardial protection during cardiac surgery.
- Multidose cardioplegia is standard, but single-dose alternatives are being explored for improved efficiency and outcomes.
Purpose of the Study:
- To compare the efficacy and safety of single-dose cardioplegia (del Nido and histamine-tryptophan-ketoglutarate) versus multidose cardioplegia in adult cardiac surgery patients.
- To evaluate the impact on primary outcomes (mortality) and secondary outcomes (ischemic and cardiopulmonary bypass times, reperfusion fibrillation, cardiac enzymes, myocardial infarction).
Main Methods:
- A meta-analysis was performed on randomized controlled trials and propensity-score matched cohorts.
- Identified studies were searched via medical engines, including 5516 patients.
- Primary and secondary endpoints were analyzed, with subgroup and meta-regression analyses for moderators like surgery type and ejection fraction.
Main Results:
- Del Nido cardioplegia significantly reduced ischemic time, cardiopulmonary bypass time, reperfusion fibrillation, and cardiac enzyme levels compared to multidose cardioplegia.
- Histamine-tryptophan-ketoglutarate did not show these benefits and increased cardiopulmonary bypass time and reperfusion fibrillation.
- No significant differences in mortality or myocardial infarction were observed between single-dose and multidose cardioplegia.
Conclusions:
- Del Nido cardioplegia offers significant advantages over multidose cardioplegia by decreasing operative times, reducing reperfusion fibrillation, and lowering cardiac enzyme surges.
- Histamine-tryptophan-ketoglutarate did not demonstrate comparable benefits.
- Del Nido cardioplegia represents a promising single-dose strategy for myocardial protection in adult cardiac surgery.
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.
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