Al-Hasan-Al-Saegh Sadeq, Takemoto Sho, Benenati Stefano, Shafiei Saeed, Yavuz Senol, Galli Mattia, Helms Florian, Amanov Lukman, De Manna Nunzio Davide, Torabi Saeed, Karsten Jan, Schmitto Jan Dieter, Ius Fabio, Kaufeld Tim, Salman Jawad, Popov Aron-Frederik, Schmack Bastian, Ruhparwar Arjang, Zubarevich Alina, Weymann Alexander
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany.
Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
J Clin Med. 2024 Nov 19;13(22):6977. doi: 10.3390/jcm13226977.
: 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. : 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. : 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). : 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.
在微创心脏手术（MICS）中，心脏停搏液的最佳选择仍存在争议，因为延长心肌保护对于避免手术流程中断至关重要，这可能会延长主动脉阻断时间和体外循环时间，尤其是在受限的手术视野中。我们进行了一项网状Meta分析，以评估德尔尼多（DN）、组氨酸 - 色氨酸 - 酮戊二酸（HTK）、血液停搏液（BC）和圣托马斯（STH）溶液在MICS中的安全性和有效性。：对医学电子数据库进行了全面检索，无时间限制，包括除研究方案和动物研究之外的所有类型研究。最终检索于2024年6月完成。随后，对主要和次要终点进行了网状Meta回归分析，使用R（R统计计算基金会，版本3.6.2）进行分析。使用Review Manager软件进行Meta分析。：共有15项研究，纳入2282例患者，纳入分析。四种心脏停搏液之间的院内死亡率比较均未显示出统计学上的显著差异（BC与HTK比较，OR：3.21，95%CI：0.13 - 80.84；DN与HTK比较，OR：1.42，95%CI：0.28 - 7.23；STH与HTK比较，OR：1.25，95%CI：0.19 - 8.20）。：在这项关于MICS中心脏停搏液的网状Meta分析中，各溶液的主要临床结局未观察到显著差异。发现能单剂量提供持久心肌保护的心脏停搏液，如DN和HTK，可安全应用于MICS。DN与较短的体外循环时间相关，HTK与较短的住院时间相关，尽管这些差异可能没有临床意义。
