A Systematic Review and Meta-Analysis of del Nido Versus Conventional Cardioplegia in Adult Cardiac Surgery.
Innovations (Phila)
; 14(5): 385-393, 2019 Oct.
Article
en En
| MEDLINE
| ID: mdl-31347414
ABSTRACT
OBJECTIVE:
Del Nido cardioplegia (DC) has been used extensively in pediatric cardiac surgery but the efficacy and safety in adults remains uncertain. Our objective was to perform a systematic review and meta-analysis comparing DC and blood cardioplegia (BC) in our primary endpoint of 30-day or in-hospital mortality as well as other efficacy and safety endpoints.METHODS:
Both MEDLINE and EMBASE were searched from 1996 to 2017 for studies comparing DC and BC. Data were extracted by 2 independent investigators and aggregated in a random effects model.RESULTS:
One randomized controlled trial (n = 89), 7 adjusted (n = 1,104), and 5 unadjusted observational studies (n = 717) were included. There was no difference in in-hospital mortality between DC and BC (relative risk0.67, 95% confidence interval [CI] 0.22, 2.07; P = 0.49). DC reduced cardioplegia volume requirements (mean difference [MD]-1.1 L, 95% CI, -1.6, -0.6; P < 0.0001), aortic cross-clamp time (MD -8 minutes, 95% CI, -12, -3; P = 0.0004), and cardiopulmonary bypass (CPB) times (MD -8 minutes, 95% CI, -14, -3; P = 0.03). DC reduced troponin release (standardized MD -0.3, 95% CI, -0.5, -0.1; P = 0.001). In-hospital outcomes of stroke, atrial fibrillation, acute kidney injury/dialysis, low cardiac output state, blood transfusion, reoperation rate, postoperative left ventricular EF, intensive care unit length of stay (LOS), and in-hospital LOS were comparable between groups.CONCLUSIONS:
DC is a safe alternative to BC in routine adult cardiac surgery. Its use is associated with reduction in CPB and aortic cross-clamp times and may potentially offer improved myocardial protection.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Paro Cardíaco Inducido
/
Procedimientos Quirúrgicos Cardíacos
Tipo de estudio:
Clinical_trials
/
Etiology_studies
/
Observational_studies
/
Systematic_reviews
Límite:
Adult
/
Humans
Idioma:
En
Revista:
Innovations (Phila)
Año:
2019
Tipo del documento:
Article
País de afiliación:
Canadá