Which is better for pediatric and adult cardiac surgery: del Nido or St. Thomas cardioplegia? A systematic review and meta-analysis

Ahmed K Awad; Merihan A Elbadawy; Ahmed Sayed; Mahmoud Shabaan Abdeljalil; Ahmed Abdelmawla; Adham Ahmed

doi:10.1007/s12055-023-01553-0

Which is better for pediatric and adult cardiac surgery: del Nido or St. Thomas cardioplegia? A systematic review and meta-analysis

Indian J Thorac Cardiovasc Surg. 2023 Nov;39(6):588-600. doi: 10.1007/s12055-023-01553-0. Epub 2023 Aug 1.

Authors

Ahmed K Awad¹, Merihan A Elbadawy¹, Ahmed Sayed¹, Mahmoud Shabaan Abdeljalil¹, Ahmed Abdelmawla¹, Adham Ahmed²

Affiliations

¹ Faculty of Medicine, Ain Shams University, Cairo, Egypt.
² City University of New York School of Medicine, 1589 Amsterdam Avenue, New York, NY 10031 USA.

PMID: 37885929
PMCID: PMC10597914 (available on 2024-11-01)
DOI: 10.1007/s12055-023-01553-0

Abstract

Background: Although recently it has been extended for use in adult cardiac surgery, del Nido cardioplegia was originally indicated for pediatric cardiac surgery. In this meta-analysis, we compare del Nido cardioplegia vs St. Thomas cardioplegia in pediatric and adult cardiac surgery.

Methods: A comprehensive systematic literature review was performed to identify observational and randomized controlled trials (RCTs) comparing del Nido cardioplegia with St. Thomas cardioplegia. An analysis of both random and fixed effects was conducted. The measure of the effect was by the mean difference (MD) and the risk ratio (RR) with a 95% confidence interval (95% CI).

Results: A total of 1893 patients from 12 studies were included (5 RCTs and 7 observational studies). Compared to St. Thomas solution, del Nido cardioplegia was associated with a shorter aortic cross-clamp in adult cardiac surgery (RCT MD - 19.83, 95% CI - 21.89-17.78; observational - 5.85; 95% CI - 11.59, - 0.11 respectively), but no difference in pediatric cardiac surgery. Additionally, del Nido cardioplegia was associated with lower cardiopulmonary bypass time in both adults (observational, MD - 29.15; 95% CI - 31.76-26.55) and pediatric cardiac surgery (RCTs, MD - 7.15; 95% CI - 13.25-1.05). Defibrillation rates were also significantly lower with del Nido cardioplegia group in both adult (RR 0.35, 95% CI 0.24-0.50, I² = 50%) and pediatric cardiac surgery (odds ratio (OR) 0.30, 95% CI 0.18-0.49, I² = 92%).

Conclusion: In both adults and pediatric cardiac surgery, del Nido cardioplegia helps in lowering cardiopulmonary bypass duration, defibrillation rates, and hospital stay, compared to St. Thomas solution. Among adults, del Nido cardioplegia lessens the aortic cross clamp times with no difference observed in all-cause mortality, intensive care unit stay, or mechanical ventilation.

Keywords: Cardiac surgery; Cardioplegia; St. Thomas Cardioplegia; del Nido cardioplegia.

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