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Blood Versus Crystalloid Cardioplegia in Pediatric Cardiac Surgery: A Systematic Review and Meta-analysis

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Abstract

The benefit of blood cardioplegia (BCP) compared to crystalloid cardioplegia (CCP) is still debatable. Our aim was to systematically review and synthesize all available evidence on the use of BCP and CCP to assess if any modality provides superior outcomes in pediatric cardiac surgery. A systematic literature search of the PubMed and Cochrane databases was performed with respect to the PRISMA statement (end-of-search date: January 30th, 2017). We extracted data on study design, demographics, cardioplegia regimens, and perioperative outcomes as well as relevant biochemical markers, namely cardiac troponin I (cTnI), lactate, and ATP levels at baseline, after reperfusion and postoperatively at 1, 4, 12, and 24 h as applicable. Data were appropriately pooled using random and mixed effects models. Our systematic review includes 56 studies reporting on a total of 7711 pediatric patients. A meta-analysis of the 10 eligible studies directly comparing BCP (n = 416) to CCP (n = 281) was also performed. There was no significant difference between the two groups with regard to cTnI and Lac at any measured time point, ATP levels after reperfusion, length of intensive care unit stay (WMD: −0.08, 95% CI −1.52 to 1.36), length of hospital stay (WMD: 0.13, 95% CI −0.85 to 1.12), and 30-day mortality (OR 1.11, 95% CI 0.43–2.88). Only cTnI levels at 4 h postoperatively were significantly lower with BCP (WMD: −1.62, 95% CI −2.07 to −1.18). Based on the available data, neither cardioplegia modality seems to be superior in terms of clinical outcomes, ischemia severity, and overall functional recovery.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Warren 11, 55 Fruit Street, Boston, MA, 02114, USA

    Konstantinos S. Mylonas

  2. Surgery Working Group, Society of Junior Doctors, Athens, Greece

    Konstantinos S. Mylonas, Aspasia Tzani, Panagiotis Metaxas, Dimitrios Schizas & Konstantinos P. Economopoulos

  3. First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Dimitrios Schizas

  4. Athens University of Economics and Business, Athens, Greece

    Vasileios Boikou

  5. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Konstantinos P. Economopoulos

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Contributions

Study concept and design: KSM, AT. Acquisition of data: AT, PM. Analysis and interpretation of data: KSM, AT, PM, DS, VB, KPE. Drafting of the manuscript: KSM, AT, PM. Critical revision of the manuscript for important intellectual content: KSM, AT, PM, DS, VB, KPE. Statistical analysis: VB, KSM. Supervision: KPE.

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Correspondence to Konstantinos S. Mylonas.

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Mylonas, K.S., Tzani, A., Metaxas, P. et al. Blood Versus Crystalloid Cardioplegia in Pediatric Cardiac Surgery: A Systematic Review and Meta-analysis. Pediatr Cardiol 38, 1527–1539 (2017). https://doi.org/10.1007/s00246-017-1732-4

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  • DOI: https://doi.org/10.1007/s00246-017-1732-4

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