Comparison Between HTK Solution And Blood Cardioplegia In Myocardial Protection Effects During Aortic Surgery : A Meta-analysis

Objectives:The Meta analysis was performed to compare the myocardial protective effects of HTK solution and blood cardioplegia in adult large vascular surgery.To explore which kind of myocardial protective solution is more suitable for long cross-clamp aortic surgery.Methods:By using relevant search terms and search methods to retrieve major biomedical databases on a computer,including Cochrane library,Pub Med,EMBase,China Biology Medicine database(CBM),CNKI,WANFANG,VIP,etc.The retrieval date is from the day database constructed to January 2020.Collecting relevant literature on the comparison of the myocardial protection effect between HTK solution and blood cardioplegia in adult large vascular surgery,and browsing the related literature references,possible related references can be retrieved manually.Establishing strict inclusion and exclusion criteria.For selected literature about randomized controlled studies,the Cochrane system tool was used to evaluate the literature quality,while for non-randomized controlled studies,the list of MINORS was used to evaluate the literature quality.After extracting effective data,Rev Man 5.3 software and stata14.0software were used for statistical analysis.Using ratio ratio(OR)and weighted mean difference(WMD)as the effect indexes,and the 95%confidence interval(CI)of each effect was given.According to the P value and I~2statistics in the Q value statistic test,the fixed effects model was used to combined effect in the studies without statistical heterogeneity(P>0.1,I~2<50%),otherwise,through the sensitivity analysis to find the causes of heterogeneity,after eliminating the article which resulted in major statistical heterogeneity,then continued to combined effect by using fixed effects model,.By observing the funnel graph symmetry to evaluate whether there is a publication bias,and evaluatig Begg’s and Egger’s tests.Results:Finally,6 studies met the inclusion criteria in this study,including 2 RCTS and 4retrospective analyses,with a total of 459 patients,including 230 in the HTK solution group(experimental group)and 229 in the blood cardioplegia group(control group).The results of Meta analysis showed that no statistically significant differences were found in the aspect of spontaneous self-beating rate(OR=1.07,95%CI:0.64～1.78,Z=0.26 P=0.80),post-operative fatality within 30 days(OR=0.60,95%CI:0.26～1.40,Z=1.19 P=0.23),ICU caring time(WSD=-0.21,95%CI:-0.63～0.22,Z=0.94P=0.35),mechanical ventilation time(WSD=-0.24,95%CI:-1.10～0.62,Z=0.54P=0.59)and postoperative CK of the first day(WSD=-15.87,95%CI:-103.40～71.66,Z=0.36 P=0.72).The amount of dopamine(WSD=-0.07,95%CI:-0.11～0.02,Z=2.87P=0.004)used in the two groups existed statistically significant.Conclusion:In adult vascular surgery,there were no significant differences between the two groups in the aspects of spontaneous self-beating rate,post-operative fatality within30 days,ICU caring time,mechanical ventilation time and postoperative CK of the first day.However,in terms of the amount of dopamine,the HTK solution group was slightly better than the blood cardioplegia group.In conclusion,the myocardial protective effect of HTK solution was slightly better than that of the blood-containing cardioplegia solution,and the infusion of HTK solution could simplify the surgical operation of complex surgery.