Adding blood to st thomas solution does not improve mortality in pediatric cardiac surgery: a meta-analysis of a homogenous population

Abstract

Background: Cardioplegia is the gold standard for providing ideal operating conditions while effecting myocardial protection. Some studies suggest that adding blood to St Thomas cardioplegia solution improves efficacy; this is generally accepted as true. However, the few meta-analyses conducted on children have pooled heterogeneous populations; this raises concern about the validity of their conclusions. Methods: PUBMED, the Cochrane Library and Google Scholar were searched systematically until March 2019 using the search terms “cardioplegia”; “myocardial protection”; “pediatric” “pediatric”; “children”; “infants”; “neonates”. Full text articles were examined if abstracts revealed that the studies possibly contained a blood cardioplegia arm and a crystalloid cardioplegia arm. Studies were included in the meta-analysis if they had a 4:1 blood cardioplegia arm and a St Thomas solution arm. Meta-analysis was performed using Meta-Mar software. Results: The search retrieved 423 articles; 5 were included in the meta-analysis, representing 324 patients. The risk ratio for operative mortality was 0.77(95% CI 0.24–2.5; p=0.66). Little evidence was seen of heterogeneity of the pooled patients. Conclusion: Adding blood to St Thomas cardioplegia solution did not improve in-hospital operative mortality; this may have implications for use of blood cardioplegia

Background: Cardioplegia is the gold standard for providing ideal operating conditions while effecting myocardial protection. Some studies suggest that adding blood to St Thomas cardioplegia solution improves efficacy; this is generally accepted as true. However, the few meta-analyses conducted on children have pooled heterogeneous populations; this raises concern about the validity of their conclusions. Methods: PUBMED, the Cochrane Library and Google Scholar were searched systematically until March 2019 using the search terms “cardioplegia”; “myocardial protection”; “pediatric” “pediatric”; “children”; “infants”; “neonates”. Full text articles were examined if abstracts revealed that the studies possibly contained a blood cardioplegia arm and a crystalloid cardioplegia arm. Studies were included in the meta-analysis if they had a 4:1 blood cardioplegia arm and a St Thomas solution arm. Meta-analysis was performed using Meta-Mar software. Results: The search retrieved 423 articles; 5 were included in the meta-analysis, representing 324 patients. The risk ratio for operative mortality was 0.77(95% CI 0.24–2.5; p=0.66). Little evidence was seen of heterogeneity of the pooled patients. Conclusion: Adding blood to St Thomas cardioplegia solution did not improve in-hospital operative mortality; this may have implications for use of blood cardioplegia