Abstract
Objective
This meta-analysis aimed to compare clinical outcomes of warm and cold cardioplegia in cardiac surgeries, with trial sequential analysis used to determine the conclusiveness of the results.
Methods
Electronic searches were performed on PubMed, Medline, Scopus, EMBASE and Cochrane library to identify all studies that compared warm and cold cardioplegia in cardiac surgeries. Primary endpoints were in-hospital or 30-day mortality, myocardial infarction (MI), low cardiac output syndrome (LCOS), intra-aortic balloon pump (IABP) use, stroke, and new atrial fibrillation (AF). Secondary endpoints were acute kidney injury (AKI), hospital length of stay (LOS), intensive care unit length of stay (ICU LOS), aortic cross-clamp (ACx) time and cardiopulmonary bypass (CPB) time. Pre-specified subgroup analysis were performed for (1) studies published since publication of Fan et al in 2010 1, (2) studies with low risk of bias, (3) coronary artery bypass graft (CABG) surgeries, and (4) studies with cold blood versus those with cold crystalloid cardioplegia. Trial sequential analysis (TSA) was performed to determine conclusiveness of the results, using on all outcomes without significant heterogeneity from studies of low risk of bias.
Results
No significant differences were found between post-operative rates of mortality, MI, LCOS, IABP use, stroke, new AF, and AKI between warm and cold cardioplegia. TSA concluded that current evidence was sufficient to rule out a 20% relative risk reduction in these outcomes.
Conclusions
Concerning safety outcomes, current evidence suggests that the choice between warm and cold cardioplegia remains in the surgeon’s preference.
This meta-analysis aimed to compare clinical outcomes of warm and cold cardioplegia in cardiac surgeries, with trial sequential analysis used to determine the conclusiveness of the results.
Methods
Electronic searches were performed on PubMed, Medline, Scopus, EMBASE and Cochrane library to identify all studies that compared warm and cold cardioplegia in cardiac surgeries. Primary endpoints were in-hospital or 30-day mortality, myocardial infarction (MI), low cardiac output syndrome (LCOS), intra-aortic balloon pump (IABP) use, stroke, and new atrial fibrillation (AF). Secondary endpoints were acute kidney injury (AKI), hospital length of stay (LOS), intensive care unit length of stay (ICU LOS), aortic cross-clamp (ACx) time and cardiopulmonary bypass (CPB) time. Pre-specified subgroup analysis were performed for (1) studies published since publication of Fan et al in 2010 1, (2) studies with low risk of bias, (3) coronary artery bypass graft (CABG) surgeries, and (4) studies with cold blood versus those with cold crystalloid cardioplegia. Trial sequential analysis (TSA) was performed to determine conclusiveness of the results, using on all outcomes without significant heterogeneity from studies of low risk of bias.
Results
No significant differences were found between post-operative rates of mortality, MI, LCOS, IABP use, stroke, new AF, and AKI between warm and cold cardioplegia. TSA concluded that current evidence was sufficient to rule out a 20% relative risk reduction in these outcomes.
Conclusions
Concerning safety outcomes, current evidence suggests that the choice between warm and cold cardioplegia remains in the surgeon’s preference.
| Original language | English |
|---|---|
| Journal | Journal of Thoracic and Cardiovascular Surgery |
| Publication status | Accepted/In press - 18 Feb 2021 |