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Comparative effects of different types of cardioplegia in cardiac surgery: A network meta-analysis
Jia Tan1, Siwei Bi2, Jingyi Li3
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Del Nido (DN) cardioplegia may reduce perioperative mortality in adults compared to histidine-tryptophan-ketoglutarate (HTK) and blood cardioplegia (BC). HTK may lower atrial fibrillation risk versus BC or DN in adult cardiac surgery patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Anesthesiology
Background:
- Cardioplegia solutions are crucial for myocardial protection during cardiac surgery.
- Comparing the efficacy and safety of different cardioplegia types is essential for optimizing patient outcomes.
Conclusions:
- Del Nido (DN) cardioplegia may offer improved perioperative survival for adult cardiac surgery patients compared to HTK and BC.
- Histidine-tryptophan-ketoglutarate (HTK) may be associated with a reduced risk of atrial fibrillation compared to BC and DN in adults.
Objective:
To compare the outcomes of four types of cardioplegia during cardiac surgery: del Nido (DN), blood cardioplegia (BC), histidine-tryptophan-ketoglutarate (HTK) and St. Thomas.
Methods:
Randomized controlled trials (RCTs) and observational cohort studies from 2005 to 2021 were identified in PubMed, Embase, and Cochrane databases. Data were extracted for the primary endpoint of perioperative mortality as well as the following secondary endpoints: atrial fibrillation, renal failure, stroke, use of an intra-aortic balloon pump, re-exploration, intensive care unit stay and hospital stay. A network meta-analysis comparing all four types of cardioplegia was performed, as well as direct meta-analysis comparing pairs of cardioplegia types.
Results:
Data were extracted from 18 RCTs and 49 observational cohort studies involving 18,191 adult patients (55 studies) and 1,634 children (12 studies). Among adult patients, risk of mortality was significantly higher for HTK (1.89, 95% CI 1.10, 3.52) and BC (RR 1.73, 95% CI 1.22, 2.79) than for DN. Risk of atrial fibrillation was significantly higher for BC (RR 1.41, 95% CI 1.09, 1.86) and DN (RR 1.51, 95% CI 1.15, 2.03) than for HTK. Among pediatric patients, no significant differences in endpoints were observed among the four types of cardioplegia.
Conclusions:
This network meta-analysis suggests that among adult patients undergoing cardiac surgery, DN may be associated with lower perioperative mortality than HTK or BC, while risk of atrial fibrillation may be lower with HTK than with BC or DN.
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