Key result
Del Nido cardioplegia shows no in-hospital mortality benefit over HTK or other solutions in minimally invasive surgery.
Why the study?
The optimal choice of cardioplegia solution in minimally invasive cardiac surgeries remains debated due to the need for prolonged myocardial protection to avoid surgical interruptions.
Does the choice of cardioplegia solution (DN, HTK, BC, STH) improve in-hospital mortality or surgical times in patients undergoing minimally invasive cardiac surgeries?
Meta-Analysis (n=2,282)
Does the choice of cardioplegia solution (DN, HTK, BC, STH) improve in-hospital mortality or surgical times in patients undergoing minimally invasive cardiac surgeries?
Odds Ratio: 1.42 (95% CI 0.28–7.23)
There are no significant differences in major clinical outcomes among del Nido, HTK, blood cardioplegia, and St. Thomas' solutions in minimally invasive cardiac surgeries, supporting the safe use of single-dose solutions like DN and HTK.
Supports flexible cardioplegia selection without mortality concern; reinforces equivalence among solutions in minimally invasive cardiac surgery.
Background/Objectives: The optimal choice of cardioplegia solution in minimally invasive cardiac surgeries (MICS) remains debated, as prolonged myocardial protection is essential to avoid interruptions to the surgical flow, which can prolong aortic cross-clamp time and cardiopulmonary bypass time, especially in the constrained surgical field. We conducted a network meta-analysis to evaluate the safety and efficacy of the del Nido (DN), histidine-tryptophan-ketoglutarate (HTK), blood cardioplegia (BC), and St. Thomas’ (STH) solutions in MICS. Methods: Medical electronic databases were thoroughly searched without time restrictions, including all types of studies except for study protocols and animal research. The final search was completed in June 2024. Subsequently, a network meta-regression was performed on both primary and secondary endpoints, utilizing R (The R Foundation for Statistical Computing, version 3.6.2) for the analysis. Meta-analyses were carried out using Review Manager software. Results: A total of 15 studies, enrolling 2282 patients, were included in the analysis. None of the comparisons showed statistically significant differences in in-hospital mortality between the four cardioplegia solutions (BC vs. HTK, OR: 3.21, 95% CI: 0.13–80.84; DN vs. HTK, OR: 1.42, 95% CI: 0.28–7.23; STH vs. HTK, OR: 1.25, 95% CI: 0.19–8.20). Conclusions: In this network meta-analysis of cardioplegia solutions in MICS, no significant differences were observed in major clinical outcomes across the solutions. Cardioplegia solutions that provide long-lasting myocardial protection with a single dose, such as DN and HTK, were found to be safely applied in MICS. DN was associated with shorter CPB times and HTK was associated with shorter hospital stays, though these differences may not have clinical implications.
No takes yet. Share an insight, caveat, or question.
Al-Hasan-Al-Saegh et al. (2024) conducted a meta-analysis in Minimally invasive cardiac surgery (n=2,282). del Nido (DN) cardioplegia vs. Histidine-tryptophan-ketoglutarate (HTK) cardioplegia was evaluated on In-hospital mortality (OR 1.42, 95% CI 0.28-7.23). Del Nido cardioplegia showed no significant difference in in-hospital mortality compared to HTK cardioplegia (OR 1.42) or other solutions in patients undergoing minimally invasive cardiac surgery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: