Open Access

REVIEW

Effect of Cardioplegia for Myocardial Protection in Pediatric Cardiac Surgery: A Network Meta-Analysis

Ke Zhou1, Dongyu Li1, Xintong Zhang2, Wensheng Wang1, Shusen Li1, Guang Song2,*
1 Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China
2 Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
* Corresponding Author: Guang Song. Email:

Congenital Heart Disease 2021, 16(6), 609-645. https://doi.org/10.32604/CHD.2021.016396

Received 03 March 2021; Accepted 26 April 2021; Issue published 08 July 2021

Abstract

Cardioplegia has been widely used to reduce myocardial injury during pediatric cardiac surgery; however, which cardioplegia solution has the best protective effect has not been established. Thus, we compared the myocardial protective effects of different cardioplegia solutions used in pediatric cardiac surgery. Seven databases were searched to identify the relevant randomized controlled trials. A network meta-analysis with a Bayesian framework was conducted. The outcomes included the following biochemical and clinical outcomes: serum concentrations of the creatine kinase-myocardial band at 6 h postoperatively; cardiac troponin I (cTnI) at 4, 12, and 24 h postoperatively; spontaneous beating after declamping; postoperative arrhythmias; inotropic support percentage and duration; mechanical ventilation hours; intensive care unit stay in days; hospital stay in days; and mortality. The group treated with cold crystalloid cardioplegia (cCCP) was chosen as the control group. The 22 studies involved 1529 patients. Six types of cardioplegia solutions were described in these studies, including cold blood cardioplegia, cCCP, del Nido, histidine-tryptophan-ketoglutarate (HTK), terminal warm blood cardioplegia, and warm blood cardioplegia (wBCP). The serum concentrations of the 24-h cTnI with wBCP (MD = −2.52, 95% CI: −4.74 to −0.27) was significantly lower than cCCP. The serum concentrations of the 24-h cTnI with HTK (MD = 4.91, 95%CI: 2.84–7.24) was significantly higher than cCCP. There was no significant difference in other biochemical and clinical outcomes when compared to cCCP. In conclusion, wBCP may have a superior myocardial protective effect with lower 24-h cTnI levels postoperatively and similar clinical outcomes after pediatric cardiac surgery.

Keywords

Cardioplegia; pediatric cardiac surgery; cardiac troponin I; meta-analysis

Cite This Article

Zhou, K., Li, D., Zhang, X., Wang, W., Li, S. et al. (2021). Effect of Cardioplegia for Myocardial Protection in Pediatric Cardiac Surgery: A Network Meta-Analysis. Congenital Heart Disease, 16(6), 609–645.



This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
  • 1189

    View

  • 930

    Download

  • 0

    Like

Share Link

WeChat scan