Objective:

Although the application of del Nido cardioplegia solution (DNC) in adult cardiac surgery is accumulating, the feasibility and safety of this myocardial protection strategy in adults remains controversial. We aimed to update our previous meta-analysis to determine the myocardial protective effect of DNC versus conventional cardioplegia (CC) in adult cardiac surgery.

Methods:

A comprehensive literature search was performed using PubMed, EMBASE, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2020.

Results:

Thirty-seven observational studies and four randomized controlled trials (RCTs) including 21,779 patients were identified. The DNC group was associated with decreased postoperative cardiac enzymes [troponin T (cTnT) and creatine kinase-MB (CK-MB)] [standardized mean differences (SMD): −0.59, 95% confidence interval (CI): −0.99 to −0.19, p = 0.004], cardiopulmonary bypass (CPB) time (MD: −9.31, 95% CI: −13.10 to −5.51, p < 0.00001), aortic cross-clamp (ACC) time (MD: −7.20, 95% CI: −10.31 to −4.09, p < 0.00001), and cardioplegia volume (SMD: −1.95, 95% CI: −2.46 to −1.44, p < 0.00001). Intraoperative defibrillation requirement was less in the DNC group [relative risk (RR): 0.50, 95% CI: 0.33 to 0.75, p = 0.0007]. The pooled analysis revealed no significant difference in operative mortality among the patients assigned to DNC and those undergoing CC.

Conclusion:

In adult cardiac surgery, compared to CC, myocardial protection used with DNC yield similar or better short-term clinical outcomes. More high-quality trials and RCTs reflecting long-term follow-up morbidity and mortality are required in the future to confirm these findings.

中文翻译：

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Del Nido 心脏停搏液在成人心脏手术中保护心肌：一项系统回顾和更新的荟萃分析

客观的：

尽管del Nido心脏停搏液（DNC）在成人心脏手术中的应用不断积累，但这种心肌保护策略在成人中的可行性和安全性仍存在争议。我们的目的是更新我们之前的荟萃分析，以确定 DNC 与传统心脏停搏液 (CC) 在成人心脏手术中的心肌保护作用。

方法：

截至 2020 年 11 月，使用 PubMed、EMBASE、Cochrane 图书馆和国际临床试验注册平台数据库进行了全面的文献检索。

结果：

确定了 37 项观察性研究和 4 项随机对照试验 (RCT)，包括 21,779 名患者。DNC 组与术后心肌酶[肌钙蛋白 T (cTnT) 和肌酸激酶-MB (CK-MB)] 降低相关[标准化均值差 (SMD)：-0.59，95% 置信区间 (CI)：-0.99 至 - 0.19，p = 0.004]，体外循环 (CPB) 时间（MD：-9.31，95% CI：-13.10 至 -5.51，p < 0.00001），主动脉钳夹（ACC）时间（MD：-7.20，95% CI：-10.31 至 -4.09，p < 0.00001）和心脏停搏液容积（SMD：-1.95，95% CI：-2.46 至 -1.44，p < 0.00001）。DNC 组的术中除颤要求较低 [相对风险 (RR)：0.50，95% CI：0.33 至 0.75，p = 0.0007]。

结论：

在成人心脏手术中，与 CC 相比，与 DNC 一起使用的心肌保护产生相似或更好的短期临床结果。未来需要更多反映长期随访发病率和死亡率的高质量试验和随机对照试验来证实这些发现。