A Systematic Review and Meta-Analysis of del Nido Versus Conventional Cardioplegia in Adult Cardiac Surgery

Objective: Del Nido cardioplegia (DC) has been used extensively in pediatric cardiac surgery but the efficacy and safety in adults remains uncertain. Our objective was to perform a systematic review and meta-analysis comparing DC and blood cardioplegia (BC) in our primary endpoint of 30-day or in-hospital mortality as well as other efficacy and safety endpoints. Methods: Both MEDLINE and EMBASE were searched from 1996 to 2017 for studies comparing DC and BC. Data were extracted by 2 independent investigators and aggregated in a random effects model. Results: One randomized controlled trial (n = 89), 7 adjusted (n = 1,104), and 5 unadjusted observational studies (n = 717) were included.There was no difference in in-hospital mortality between DC and BC (relative risk:0.67,95% confidence interval [CI]: 0.22, 2.07; P = 0.49). DC reduced cardioplegia volume requirements (mean difference [MD]:-1.1 L, 95% CI, -1.6,-0.6; P < 0.0001), aortic cross-clamp time (MD: -8 minutes, 95% CI, -12, -3; P = 0.0004), and cardiopulmonary bypass (CPB) times (MD: -8 minutes, 95% CI, -14, -3; P = 0.03). DC reduced troponin release (standardized MD: -0.3, 95% CI, -0.5, -0.1; P = 0.001). In-hospital outcomes of stroke, atrial fibrillation, acute kidney injury/dialysis, low cardiac output state, blood transfusion, reoperation rate, postoperative left ventricular EF, intensive care unit length of stay (LOS), and in-hospital LOS were comparable between groups. Conclusions: DC is a safe alternative to BC in routine adult cardiac surgery. Its use is associated with reduction in CPB and aortic cross-clamp times and may potentially offer improved myocardial protection.