Ivancarmine Gambardella1, Mario F L Gaudino2, George A Antoniou3, Mohamad Rahouma2, Berhane Worku4, Robert F Tranbaugh4, Francesco Nappi5, Leonard N Girardi2. 1. 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. Electronic address: icg9002@med.cornell.edu. 2. Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Medical Center, New York, NY. 3. Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY; Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom. 4. 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. 5. Cardiac Surgery Center, Cardiologique du Nord de Saint-Denis, Paris, France.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: DN decreases operative times, reperfusion fibrillation, and surge of cardiac enzymes compared with multidose cardioplegia.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: DN decreases operative times, reperfusion fibrillation, and surge of cardiac enzymes compared with multidose cardioplegia.
Authors: Emily Honzel; Samantha Nemeth; Brigitte E Kazzi; Alexander P Kossar; Jocelyn Sun; Yuji Kaku; Koji Takeda; Hiroo Takayama; Michael Argenziano; Jessica Spellman; Andrea Miltiades; Kenmond Fung; James Beck; Craig R Smith; Paul Kurlansky; Isaac George Journal: Eur J Cardiothorac Surg Date: 2022-10-04 Impact factor: 4.534
Authors: Alex M D'Angelo; Samantha Nemeth; Catherine Wang; Alexander P Kossar; Koji Takeda; Hiroo Takayama; Vinayak Bapat; Yoshifumi Naka; Michael Argenziano; Craig R Smith; James Beck; Jessica Spellman; Paul Kurlansky; Isaac George Journal: Interact Cardiovasc Thorac Surg Date: 2022-03-31
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