Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Medical Center, New York, NY; Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Medical Center, New York, NY.
J Thorac Cardiovasc Surg. 2020 Nov;160(5):1195-1202.e12. doi: 10.1016/j.jtcvs.2019.07.109. Epub 2019 Sep 5.
To compare outcomes of single (intervention group: del Nido [DN], and histamine-tryptophan-ketoglutarate) versus multidose (control group) cardioplegia in the adult cardiac surgery patients.
Medical search engines were interrogated to identify relevant randomized controlled trials and propensity-score matched cohorts. Meta-analysis was conducted for primary (in-hospital/30-day mortality) and secondary (ischemic and cardiopulmonary bypass [CPB] times, reperfusion fibrillation, peak of cardiac enzymes, myocardial infarction) endpoints. Subgroup analyses were conducted for study design and type of intervention, and meta-regression for primary outcome included type of surgery and left ventricular ejection fraction as moderators.
Ten randomized controlled trials and 13 propensity-score matched cohorts were included, reporting on 5516 patients. Estimates are expressed as (parameter value [OR, odds ratio; MD, mean difference; SMD, standardized mean difference]/unit of measure [95% confidence interval], P value). DN reduced ischemic time (MD, -7.18 minutes [-12.52 to -1.84], P < .01), CPB time (MD, -10.44 minutes [-18.99 to -1.88], P .01), reperfusion fibrillation (OR, 0.16 [0.05-0.54], P < .01), and cardiac enzymes (SMD -0.17 [-0.29, 0.05], P < .01) compared with multidose cardioplegia. None of these beneficial effects were reproduced by histamine-tryptophan-ketoglutarate, which instead increased CPB time (MD, 2.04 minutes [0.73-3.37], P < .01) and reperfusion fibrillation (OR, 1.80 [1.20-2.70], P < .01). There was no difference in mortality and myocardial infarction between single and multidose, independently of type of surgery or left ventricular ejection fraction.
DN decreases operative times, reperfusion fibrillation, and surge of cardiac enzymes compared with multidose cardioplegia.
比较单次（干预组：del Nido [DN]和组氨酸-色氨酸-酮戊二酸）与多次（对照组）心脏停搏液在成年心脏手术患者中的效果。
检索医学搜索引擎以确定相关的随机对照试验和倾向评分匹配队列。对主要结局（院内/30 天死亡率）和次要结局（缺血和体外循环 [CPB]时间、再灌注颤动、心肌酶峰值、心肌梗死）进行荟萃分析。对研究设计和干预类型进行亚组分析，并对主要结局进行 meta 回归，纳入手术类型和左心室射血分数作为调节变量。
共纳入 10 项随机对照试验和 13 项倾向评分匹配队列，报告了 5516 例患者的数据。估计值表示为（参数值[比值比（OR）、优势比；MD，均值差；SMD，标准化均数差]/单位[95%置信区间（CI）]，P 值）。与多次心脏停搏液相比，DN 可减少缺血时间（MD，-7.18 分钟[-12.52 至-1.84]，P<.01）、CPB 时间（MD，-10.44 分钟[-18.99 至-1.88]，P<.01）、再灌注颤动（OR，0.16[0.05-0.54]，P<.01）和心肌酶（SMD，-0.17[-0.29，0.05]，P<.01）。与多次心脏停搏液相比，组氨酸-色氨酸-酮戊二酸并没有显示出这些有益效果，反而增加了 CPB 时间（MD，2.04 分钟[0.73-3.37]，P<.01）和再灌注颤动（OR，1.80[1.20-2.70]，P<.01）。无论手术类型或左心室射血分数如何，单次与多次心脏停搏液在死亡率和心肌梗死方面均无差异。
与多次心脏停搏液相比，DN 可减少手术时间、再灌注颤动和心肌酶升高。
