Abstract
ObjectiveThis meta-analysis aimed to compare clinical outcomes of warm and cold cardioplegia in cardiac surgeries in adult patients, with trial sequential analysis (TSA) used to determine the conclusiveness of the results. MethodsElectronic 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 end points were in-hospital or 30-day mortality, myocardial infarction, low cardiac output syndrome, intra-aortic balloon pump use, stroke, and new atrial fibrillation. Secondary end points were acute kidney injury, hospital length of stay, and intensive care unit length of stay. Prespecified subgroup analyses were performed for (1) studies published since publication of Fan and colleagues in 2010, (2) randomized controlled studies, (3) studies with low risk of bias, (4) coronary artery bypass graft surgeries, and (5) studies with cold blood versus those with cold crystalloid cardioplegia. TSA was performed to determine conclusiveness of the results, using on all outcomes without significant heterogeneity from studies of low risk of bias. ResultsNo significant differences were found between post-operative rates of mortality, myocardial infarction, low cardiac output syndrome, intra-aortic balloon pump use, stroke, new atrial fibrillation, and acute kidney injury between warm and cold cardioplegia. TSA concluded that current evidence was sufficient to rule out a 20% relative risk reduction in these outcomes. ConclusionsConcerning safety outcomes, current evidence suggests that the choice between warm and cold cardioplegia remains in the surgeon's preference.
Highlights
No significant differences were found between post-operative rates of mortality, myocardial infarction, low cardiac output syndrome, intra-aortic balloon pump use, stroke, new atrial fibrillation, and acute kidney injury between warm and cold cardioplegia
trial sequential analysis (TSA) concluded that current evidence was sufficient to rule out a 20% relative risk reduction in these outcomes
Prespecified subgroup analysis was performed on (1) studies published since publication of Fan and colleagues in 20103; (2) randomized controlled trial (RCT); (3) studies with low risk of bias, defined by 5 or 7 score or more in modified Jadad scale or Newcastle–Ottawa Quality Assessment Scale (NOS), respectively; (4) coronary artery bypass graft (CABG) surgeries; and (5) studies with cold blood versus those with cold crystalloid cardioplegia
Summary
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 end points were in-hospital or 30-day mortality, myocardial infarction, low cardiac output syndrome, intra-aortic balloon pump use, stroke, and new atrial fibrillation. Prespecified subgroup analyses were performed for (1) studies published since publication of Fan and colleagues in 2010, (2) randomized controlled studies, (3) studies with low risk of bias, (4) coronary artery bypass graft surgeries, and (5) studies with cold blood versus those with cold crystalloid cardioplegia. Electronic searches were performed on PubMed, Medline, Scopus, EMBASE, and Cochrane library to identify all studies comparing warm and cold cardioplegia in cardiac surgeries regardless of publication type or language. Reference lists of papers found in the literature search were manually searched to assess suitability for inclusion in this review
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