Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
Heart Lung Circ. 2021 May;30(5):642-655. doi: 10.1016/j.hlc.2020.10.016. Epub 2020 Dec 17.
Myocardial protection in adult cardiac surgery is commonly achieved with either multidose blood cardioplegia or single-dose del Nido crystalloid cardioplegia.
The aim of this systematic review and meta-analysis was to compare the outcomes of del Nido cardioplegia versus blood cardioplegia in adult cardiac surgery.
All English-language articles were searched in MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar up to March 2020, to identify randomised control trials, prospective observational studies, and retrospective analyses (with or without propensity matching) reporting any or all of the primary and secondary endpoints. The primary endpoint was all-cause mortality. Secondary endpoints included cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) time; cardioplegia volume; need for defibrillation after AoX release; intraoperative glucose; postoperative myocardial enzyme release; postoperative left ventricular ejection fraction (LVEF); incidence of postoperative acute kidney injury (AKI), atrial fibrillation (AF), stroke, and low cardiac output syndrome (LCOS); postoperative blood transfusion; duration of mechanical ventilation; and length of intensive care unit (ICU) and hospital stay.
Twenty-nine (29) studies were included. There was no difference in the primary outcome of mortality between the two groups (odds ratio [OR], 1.18; 95% confidence interval [CI], 0.82-1.72 [p=0.37]). del Nido cardioplegia was associated with significantly shorter CPB (mean difference [MD], -7.42 minutes; 95% CI, -12.53 to -2.31 [p=0.004]) and AoX times (MD, -6.39 minutes; 95% CI, -10.30 to -2.48 [p=0.001]), and lower cardioplegia volumes. Significantly fewer patients required defibrillation after AoX release in the del Nido group. Intraoperative glucose homeostasis was better preserved in the del Nido group. Postoperative cardiac troponin T release and the number of patients needing transfusions were less in the del Nido group. No differences were seen in postoperative LVEF, or in the incidence of AKI, stroke, AF, and LCOS. Duration of mechanical ventilation, and length of ICU and hospital stay were similar.
Although this meta-analysis failed to find any mortality benefits with del Nido cardioplegia, significant benefits were seen in a number of intraoperative and postoperative variables. del Nido cardioplegia is a safe and favourable alternative to blood cardioplegia in adult cardiac surgery.
成人心脏手术中的心肌保护通常通过多剂量血液心脏停搏液或单次剂量的 del Nido 晶体心脏停搏液来实现。
本系统评价和荟萃分析的目的是比较 del Nido 心脏停搏液与血液心脏停搏液在成人心脏手术中的结果。
检索 MEDLINE（PubMed）、Cochrane 对照试验中心注册库（CENTRAL）和 Google Scholar 上截至 2020 年 3 月的所有英文文章，以确定报告任何或所有主要和次要终点的随机对照试验、前瞻性观察研究和回顾性分析（有无倾向匹配）。主要终点是全因死亡率。次要终点包括体外循环 (CPB) 和主动脉阻断 (AoX) 时间；心脏停搏液量；AoX 释放后除颤需求；术中血糖；术后心肌酶释放；术后左心室射血分数 (LVEF)；术后急性肾损伤 (AKI)、心房颤动 (AF)、中风和低心输出综合征 (LCOS) 的发生率；术后输血；机械通气时间；以及重症监护病房 (ICU) 和住院时间。
共纳入 29 项研究。两组之间的主要结局死亡率无差异（比值比 [OR]，1.18；95%置信区间 [CI]，0.82-1.72 [p=0.37]）。del Nido 心脏停搏液与 CPB 时间（平均差异 [MD]，-7.42 分钟；95%CI，-12.53 至-2.31 [p=0.004]）和 AoX 时间（MD，-6.39 分钟；95%CI，-10.30 至-2.48 [p=0.001]）更短，心脏停搏液量更低。在 del Nido 组中，AoX 释放后需要除颤的患者明显较少。del Nido 组术中葡萄糖稳态更好。del Nido 组术后心肌肌钙蛋白 T 释放和需要输血的患者数量较少。del Nido 组术后左心室射血分数或 AKI、中风、AF 和 LCOS 的发生率无差异。机械通气时间、ICU 和住院时间相似。
尽管本荟萃分析未能发现 del Nido 心脏停搏液在死亡率方面有任何益处，但在许多术中及术后变量中观察到明显益处。del Nido 心脏停搏液是成人心脏手术中血液心脏停搏液的安全且有利的替代方法。
