HTK versus multidose cardioplegias for myocardial protection in adult major vascular surgery:a meta-analysis

Qiu Bingmei; Xi Zhilong; Zhang Lei; Zhang Xiaohua; Wang Changtian

doi:10.13498/j.cnki.chin.j.ecc.2024.06.04

Abstract：Objective To study the myocardial protection effect and the clinical significance of multidose cardioplegias and HTK solution during major vascular surgery,providing insights and references for myocardial protection in complex surgeries with prolonged myocardial ischemia times. Methods The literatures in major Chinese and foreign biomedical databases (2009.05～2023.01) were searched to collect the related clinical studies on the myocardial protection effect of two groups of cardioplegia in major vascular surgery. The extracted outcome indicators were analyzed by Stata14.0 and RevMan 5.3 software for meta-statistical analysis. Results A total of 650 cases were included in 10 studies,with 338 cases in the multidose cardioplegia group and 312 cases in the HTK group. There were no statistically significant differences between the two groups in terms of aortic cross-clamping (ACC) time and 30-day mortality (P>0.05). However,significant differences were observed in cardiopulmonary bypass (CPB) time (WMD=-5.157,95％CI:-10.086～-0.229,P=0.04),ICU stay (WMD=-1.000,95％CI:-1.941～-0.059,P=0.037) and dopamine dosage (WMD=-0.066,95％CI:-0.111～-0.021,P=0.004) between the two groups. Subgroup analysis of RCTs for CPB time and ICU time showed no statistically significant differences,but the heterogeneity of these results was high,rendering them unreliable. Overall,the heterogeneity of the data was low,and the results should be referenced based on the entire dataset. Conclusion HTK solution may offer superior myocardial protection compared to multidose cardioplegic solution in adult major vascular surgery,as evidenced by its ability to shorten CPB time,ICU time and reduce the use of vasoactive drugs.