Del Nido versus conventional blood cardioplegia in tetralogy of fallot repair: A systematic review and meta-analysis of randomized controlled trials

Objectives Compare outcomes of Del Nido (DN) versus conventional blood cardioplegia (BC) in the surgical repair of Tetralogy of Fallot (ToF). Methods Medical databases were searched to identify relevant clinical trials. Meta-analysis was conducted for primary (cardiopulmonary bypass [CPB] and aortic cross-clamp [ACC] times, hospital and intensive care unit [ICU] length of stay [LOS], mechanical ventilation time) and secondary (adverse events, lactate levels, volume of additional cardioplegia) endpoints. Analysis was conducted for DN versus conventional blood cardioplegia, and we performed sensitivity analysis with leave one-out analysis for the primary outcome. Results 4 randomized controlled trials were included ( n = 275). Mean differences (MD) with 95% confidence intervals (CI) were calculated with a random-effects model. Groups had similar CPB (MD −5.76 minutes; [−23.32 to 11.80]; p = 0.52) and ACC (MD 3.06 minutes; [−13.64 to 7.52]; p = 0.57) times, ICU (MD −6.42 hours; [−25.62 to 12.78]; p = 0.51) LOS and additional cardioplegia volume (MD −195.18 mL; [−434.19 to 43.82]; p = 0.11). The DN group had shorter hospital LOS (MD −0.81 days; [−1.25 to −0.36]; p = 0.0003) and time under mechanical ventilation (MD −4.57 hours; [−8.73 to −0.42]; p = 0.03). There was no difference in mortality. Conclusions DN cardioplegia has similar clinical outcomes and operative times compared to conventional blood cardioplegia in ToF surgery.