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Chan J, Oo S, Butt S, Benedetto U, Caputo M, Angelini GD, Vohra HA. Network meta-analysis comparing blood cardioplegia, Del Nido cardioplegia and custodiol cardioplegia in minimally invasive cardiac surgery. Perfusion 2023; 38:464-472. [PMID: 35225070 DOI: 10.1177/02676591221075522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Minimally invasive cardiac surgery has been evolving, with the intention of reducing surgical trauma, improve cosmesis and patient satisfaction. Single dose, crystalloid cardioplegia such as Del Nido cardioplegia and Custoidol solution have been increasingly used to reduce the interruption from repeating cardioplegia dosing to minimise the cardiopulmonary bypass and cross clamp time. However, the best cardioplegia for myocardial protection in adult minimally invasive cardiac surgery remains controversial. We aimed to conduct a meta-analysis to analyse the current evidence in the literature. METHOD A systematic review and meta-analysis was performed following the updated 2020 PRISMA guideline. Articles published in the five major electronic databases up 1st of April 2021 were identified and reviewed. The primary outcome was in-hospital or 30-day mortality. Traditional pairwise and Bayesian network meta-analyses were conducted. RESULTS Nine articles were included in this study. The use of Del Nido cardioplegia was associated with a lower volume of cardioplegia used (Del Nido vs Blood, 1105.62 mL+/-123.47 vs 2569.46 mL+/-1515.52, p<0.001), cardiopulmonary bypass (Del Nido vs Custoidol vs Blood: 91.67+/-14.78 vs 138.05 +/- 21.30 vs 119.38+/-26.91 minutes, p<0.001) and cross-clamp time (Del Nido vs Custoidol vs Blood: 74.99+/-18.55 vs 82.01 +/- 17.28 vs 93.66+/-8.88 minutes, p < 0.001). No differences were observed in the incidence of in-hospital/30-day mortality rate, new onset of atrial fibrillation and stroke. Ranking analysis showed the Custoidol solution has the highest probability to be the first ranked cardioplegia. CONCLUSION No differences were found between blood and crystalloid cardioplegia in adult minimally invasive cardiac surgery in several clinical outcomes. The cardioplegia of choice in minimally invasive cardiac surgery remains the surgeons' decision and preference.
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Affiliation(s)
- Jeremy Chan
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Shwe Oo
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Salman Butt
- Department of Perfusion Sciences, 156611St George's Hospital, London UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, 156596Bristol Royal Hospital for Children, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
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Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia. J Cardiovasc Dev Dis 2022; 9:jcdd9060178. [PMID: 35735807 PMCID: PMC9225441 DOI: 10.3390/jcdd9060178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/01/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023] Open
Abstract
The race for an ideal cardioplegic solution has remained enthusiastic since the beginning of the modern cardiac surgery era. The Bretschneider solution, belonging to the “intracellular cardioplegic” group, is safe and practical in myocardial protection during ischemic time. Over time, some particular concerns have arisen regarding the effects on cardiac metabolism and postoperative myocardial functioning. This paper reviews the most important standpoints in terms of theoretical and practical analyses.
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Gerber W, Sanetra K, Gerber AD, Jankowska-Sanetra J, Kuczera M, Białek K, Buszman PP, Bochenek A. One-shot cardioplegia for minimally invasive mitral valve repair-a comparison of del Nido and Bretschneider Histidine-Tryptophan-Ketoglutarate solutions. Perfusion 2022; 38:763-770. [PMID: 35320027 DOI: 10.1177/02676591221080653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Minimally invasive procedures are demanding in terms of cardioprotection. In many leading centres Bretschneider HTK solution is used for mitral valve surgery. The study was designed to provide comparison of the del Nido and Bretschneider HTK protocol. METHODS Patients who underwent minimally invasive mitral valve repair for primary mitral regurgitation and received single delivery of either del Nido (Group 1) or Bretschneider HTK cardioplegia (Group 2) were matched on basis of age, gender and length of the cross-clamp time. The groups were compared in terms of major adverse cardiac and cerebrovascular events (death, myocardial infarction, stroke), high sensitivity troponin T (hs-TnT) and creatine kinase- MB isoenzyme (CK-MB) release at 12 h and 24 h following the surgery, incidence of low cardiac output syndrome (LCOS), postoperative arrhythmia, transfusions and postoperative renal function. RESULTS Case control matching selected 38 pairs of patients. None of patients died, nor suffered from myocardial infarction or stroke. Troponin values did not differ at 12 h (median: 281.0 pg/mL vs 313.0 pg/mL; p = .38) and 24 h (median: 261.0 pg/mL vs 299.0 pg/mL; p = .54), as well as CK-MB at 12 h (median: 25.0 ng/mL vs 29.0 ng/mL; p = .31) and 24 h (median: 11.0 ng/mL versus 9.6 ng/mL; p = .46). Difference in occurrence of LCOS was insignificant (2 vs 7; 5.2% vs 18.4%; p =.15). No difference was shown in incidence of postoperative arrhythmia, transfusions and renal function. CONCLUSIONS Del Nido cardioplegia can be used safely as an alternative for Bretschneider HTK for minimally invasive mitral valve surgery.
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Affiliation(s)
- Witold Gerber
- Faculty of Medicine, University of Technology, Katowice, Poland.,Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Krzysztof Sanetra
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland.,Clinic of Cardiovascular Surgery, 150516Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | | | | | - Małgorzata Kuczera
- Department of Anaesthesiology and Intensive Care, American Heart of Poland, Bielsko-Biała, Poland
| | - Krzysztof Białek
- Faculty of Medicine, University of Technology, Katowice, Poland.,Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Piotr Paweł Buszman
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland.,Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland.,Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Andrzej Bochenek
- Faculty of Medicine, University of Technology, Katowice, Poland.,Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland.,Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
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