Del Nido versus St. Thomas cardioplegia for myocardial protection in pediatric congenital heart surgery: A systematic review and meta-analysis
Main Article Content
Keywords
congenital heart disease, Cardioplegia, Del Nido, Pediatric cardiac surgery, St. Thomas
Abstract
Background: Congenital heart disease (CHD) is the most common congenital anomaly in newborns and frequently requires open-heart surgery during the neonatal period. This study aimed to determine the most effective cardioplegic solution for pediatric cardiac surgery.
Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive literature search was performed to identify studies comparing Del Nido and St. Thomas cardioplegia in pediatric CHD patients. A total of 53 studies, encompassing 1,099 patients, were included. The primary and secondary outcomes evaluated were postoperative Troponin T/I and CK-MB levels, aortic cross-clamp (ACC) time, cardiopulmonary bypass (CPB) time, intensive care unit (ICU) and hospital length of stay, vasoactive-inotropic score (VIS), and postoperative mortality.
Results: This study included 8 studies. Pooled analyses showed no significant differences between del Nido and St. Thomas for aortic cross-clamp (ACC) time (SMD −0.02; 95% CI −0.24–0.21; p=0.88; I²=65%), cardiopulmonary bypass (CPB) time (SMD −0.05; 95% CI −0.31–0.21; p=0.71; I²=73%), ICU/NICU stay (SMD 0.06; 95% CI −0.17–0.28; p=0.63; I²=66%), hospital stay (SMD −0.68; 95% CI −1.52–0.16; p=0.11; I²=65%), and postoperative mortality (OR 0.67; 95% CI 0.37–1.20; p=0.17; I²=0%). In the Tetralogy of Fallot subgroup, St. Thomas showed a borderline shorter ACC time (SMD 0.29; 95% CI −0.01–0.59; p=0.05)
Conclusion: Del Nido and St. Thomas cardioplegia solutions provide comparable long-term surgical outcomes in pediatric CHD patients. However, Del Nido cardioplegia appears to offer superior myocardial protection in the immediate postoperative period.
References
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