Article description

Summary:

• To compare del Nido with other techniques of cardioplegia on outcomes from cardiac surgery. The primary outcome was stroke and/or transient ischaemic attack (TIA) and there were 17 secondary outcomes including adverse events and estimates of surgical process.
• Systematic review and meta-analysis of randomised controlled trials (RCTs).
• The study included six randomised controlled trials with a study population sample size of 1812 patients.
• Comparators to del Nido solution included blood both warm and cold and St Thomas’s solution.
• All studies had at least a moderate risk of bias.
• Meta-analysis of primary outcome based on only three of the RCTs, found that compared to other techniques of cardioplegia, del Nido to be significantly associated with a more than 50% lower incidence of stroke and/or TIA (1.9% vs 4.6%, Odd ratio 0.43, 95% confidence intervals 0.20-0.92, p = 0.007). The finding was more than 60% influenced by one RCT with a very hight incidence of stroke in the control arm.
• As far as secondary outcomes and compared to other techniques of cardioplegia, del Nido was associated with significantly shorter duration of aortic cross clamping, less frequent defibrillation and blood transfusion and lower incidence of acute kidney injury. There was no significant difference in the other 13 outcomes and in particular mortality.

Conclusions:

• Compared to several different techniques, there was moderately robust evidence that cardioplegia with Del Nido solution was associated with a more than 50% reduction in the incidence of stroke and/or TIA.
• In addition, cardioplegia with del Nido solution was associated with a few secondary outcomes and in particular, AKI when compared to other techniques. However, the majority of secondary outcomes were not significantly different.