Comparison Of The Cardioprotection Between Crystalloid And Blood Cardioplegia In Infant Cardiac Surgery:a Meta-analysis

Objective:To compare the cardioprotection effect between blood and crystalloid cardioplegia during cardiac surgery in infant patients, and provide a theoretical basis for optimal myocardial protection strategies.Methods:A meta-analysis of randomized controlled trials (RCTs) studies about comparing blood and crystalloid cardioplegia in infant patients undergoing cardiac surgery were performed. Cochrane library (Issue2,2013), MEDLINE, EMBase, PubMed, Springer Link,Science Direct, CBM, CNKI and Wan fang were searched from from inception to March2013. Studies were assessed according to the Cochrane Handbook for systematic reviews. Data were extracted from these trials and analyzed by RevMan5.1software.Results:Twenty trials were included, contain4control study experiments about blood cardioplegia vs HTK cardioplegia,14control study experiments about blood cardioplegia vs STH cardiopiegia,9control study experiments about HTK cardioplegia vs STH cardioplegia.Meta-analysis indicated that, there were no significant differences between blood and HTK group in Serum CK after operation12h[OR=2.41,95%CI:(-0.95,5.77), P=0.16],serum CK after operation24h[OR=1.93,95%CI:(-0.41,4.26), P=0.11],serum CK-MB after operation12h[OR=1.76,95%CI:(-0.24,3.77), P=0.08],serum CK-MB after operation24h[OR=0.98,95%CI:(-0.81,2.76), P=0.28],serum CK-MB after operation48h[OR=1.00,95%CI:(-2.49,4.48), P=0.58], and serum cTnl after operation24h[OR=-0.75,95%CI:(-3.98,2.47), P=0.65]. There were significant differences between blood cardioplegia and STH cardioplegia in the incidence of postoperative arrhythmias[OR=0.24,95%CI:(0.08,0.76), P=0.02], days in hospital [OR=-1.09,95%CI:(-2.03,-0.15), P=0.02],resuscitation time[OR=-73.20,95%CI:(-111.65,-34.75), P=0.0002], but there were no significant differences in the incidence of postoperative auto-beating[OR=2.55.95%CI:(0.57,11.40), P=0.22], the incidence of postoperative low cardiac output [OR=0.24.95%CI:(0.01,7.60), P=0.41]and the hours of ventilation[OR=-0.975,95%CI:(-24.00,4.51), P=0.18]. There were significant differences between HTK cardioplegia and STH cardioplegia in he incidence of postoperative auto-beating[OR=4.96,95%CI:(1.80,13.67), P=0.002],the incidence of postoperative arrhythmias[OR=0.40,95%CI:(0.17,0.96), P=0.04], the hours of ventilation[OR=-2.50,95%CI:(-4.27,-0.73), P=0.0006], the hours in ICU [OR=-6.92,95%CI:(-12.38,-1.46), P=0.01], the days in hospital[OR=-1.98,95%Cl:(-3.02,-0.95), P=0.0002], serum CK after operation12h[OR=-541.40,95%CI:(-748.82,-333.98), P<0.00001],serum CK after operation24h[OR=-310.94,95%CI:(-425.73,-196.16), P<0.00001],serum CK-MB after operation12h[OR=-35.22,95%CI:(-52.64,-17.80), P<0.00001],serum CK-MB after operation24h[OR=-29.68,95%CI:(-44.34,-15.02), P<0.00001], serum LDH after operation12h[OR=-164.83,95%CI:(-231.69,-97.96), P<0.00001] and serum LDH after operation24h[OR=-0.15,95%CI:(-0.77,-0.47), P=0.63],but there were no significant differences in the incidence of postoperative low cardiac output [OR=0.72,95%CI:(0.15,3.56),P=0.69] and resuscitation time[OR=-1.10,95%CI:(-2.69,0.49), P=0.17].Conclusion:The current evidence shows that blood cardioplegia is no difference with HTK cardioplegia in infant patients undergoing cardiac surgery, The protective effects of blood cardioplegia and HTK cardioplegaia on immature myocardium in infants cardiac surgery are obviously better than STH cardioplegia. However, given the low methodological quality and the limited sample size of most included studies, this conclusion still needs to be further proved by conducting more strictly-designed, high-quality and large-scale RCTs. The long-term effectiveness of those3treatment modalities also needs to be observed in a longer follow-up duration.