HTK Solution Cardioplegia in Pediatric Patients: A Meta-analysis

Cardioplegia, a therapy designed to induce reversible cardiac arrest, revolutionized cardiovascular surgery. Among the various pharmacological approaches is the histidine-tryptophan-ketoglutarate (HTK) solution. Despite numerous studies, no meta-analysis has investigated the efficacy of the HTK solution in the pediatric population. Therefore, we aim to conduct a meta-analysis comparing HTK and other cardioplegia solutions in pediatric patients undergoing cardiovascular surgery. PubMed, Embase, and Cochrane databases were searched from inception through April 2024. Endpoints were computed in odds ratios (OR) with 95% confidence intervals (CI) for dichotomous variables, whereas continuous variables were compared using mean differences (MD) with 95% CI. A total of 11 studies comprising 1,349 patients were included, of whom 677 (50.19%) received HTK cardioplegia. The results were similar between groups regarding mortality (OR 0.98; 95% CI 0.29, 3.29), length of hospital stay (MD 0.32 days; 95% CI −0.88, 1.51), Mechanical ventilation (MV) (MD −17.72 hours; 95% CI −51.29, 15.85), arrhythmias (OR 1.27; 95% CI 0.83, 1.95), and delayed sternal closure (OR 0.89; 95% 0.56, 1.43). However, transfusion volume was lower in the HTK group (MD −452.39; 95% CI −890.24, −14.53; p = 0.04). The use of HTK solution was demonstrated to be similar regarding its clinical efficacy to other approaches for cardioplegia, and it may present advantages to patients prone to hypervolemia.