An Kevin R, Rahman Ishtiaq A, Tam Derrick Y, Ad Niv, Verma Subodh, Fremes Stephen E, Latter David A, Yanagawa Bobby
Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Ontario, Canada.
Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, USA.
Innovations (Phila). 2019 Oct;14(5):385-393. doi: 10.1177/1556984519863718. Epub 2019 Jul 26.
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.
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.
One randomized controlled trial ( = 89), 7 adjusted ( = 1,104), and 5 unadjusted observational studies ( = 717) were included. There was no difference in in-hospital mortality between DC and BC (relative risk:0.67, 95% confidence interval [CI]: 0.22, 2.07; = 0.49). DC reduced cardioplegia volume requirements (mean difference [MD]:-1.1 L, 95% CI, -1.6, -0.6; < 0.0001), aortic cross-clamp time (MD: -8 minutes, 95% CI, -12, -3; = 0.0004), and cardiopulmonary bypass (CPB) times (MD: -8 minutes, 95% CI, -14, -3; = 0.03). DC reduced troponin release (standardized MD: -0.3, 95% CI, -0.5, -0.1; = 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.
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.
德尔尼多停搏液（DC）已在小儿心脏手术中广泛应用，但在成人中的疗效和安全性仍不确定。我们的目的是进行一项系统评价和荟萃分析，比较DC和血液停搏液（BC）在30天或住院死亡率这一主要终点以及其他疗效和安全性终点方面的差异。
检索1996年至2017年期间MEDLINE和EMBASE数据库中比较DC和BC的研究。数据由2名独立研究人员提取，并汇总到随机效应模型中。
纳入1项随机对照试验（n = 89）、7项校正研究（n = 1,104）和5项未校正的观察性研究（n = 717）。DC和BC在住院死亡率方面无差异（相对危险度：0.67，95%置信区间[CI]：0.22，2.07；P = 0.49）。DC减少了停搏液需求量（平均差[MD]：-1.1 L，95% CI，-1.6，-0.6；P < 0.0001）、主动脉阻断时间（MD：-8分钟，95% CI，-12，-3；P = 0.0004）和体外循环（CPB）时间（MD：-8分钟，95% CI，-14，-3；P = 0.03）。DC降低了肌钙蛋白释放量（标准化MD：-0.3，95% CI，-0.5，-0.1；P = 0.001）。两组在住院期间的中风、心房颤动、急性肾损伤/透析、低心排血量状态、输血、再次手术率、术后左心室射血分数、重症监护病房住院时间（LOS）和住院LOS等结局方面相当。
在成人常规心脏手术中，DC是BC的一种安全替代方案。其应用与CPB和主动脉阻断时间的减少相关，并且可能提供更好的心肌保护。
