Introduction: Cardioplegia, a therapy designed to induce reversible cardiac arrest, revolutionized cardiovascular surgery. Among the various pharmacological approaches is the histidine-tryptophan-ketoglutarate (HTK) solution. Despite numerous studies, no meta-analysis has investigated the efficacy of the HTK solution in the pediatric population. Therefore, we aim to conduct a meta-analysis comparing HTK and other cardioplegia solutions in pediatric patients undergoing cardiovascular surgery.
Methods: PubMed, Embase, and Cochrane databases were searched from inception through April 2024. Endpoints were computed in odds ratios (OR) with 95% confidence intervals (CI) for dichotomous variables, whereas continuous variables were compared using mean differences (MD) with 95% CI.
Results: A total of 11 studies comprising 1,349 patients were included, of whom 677 (50.19%) received HTK cardioplegia. The results were similar between groups regarding mortality (OR 0.98; 95% CI 0.29, 3.29), length of hospital stay (MD 0.32 days; 95% CI -0.88, 1.51), Mechanical ventilation (MV) (MD -17.72 hours; 95% CI -51.29, 15.85), arrhythmias (OR 1.27; 95% CI 0.83, 1.95), and delayed sternal closure (OR 0.89; 95% 0.56, 1.43). However, transfusion volume was lower in the HTK group (MD -452.39; 95% CI -890.24, -14.53; = 0.04).
Conclusion: The use of HTK solution was demonstrated to be similar regarding its clinical efficacy to other approaches for cardioplegia, and it may present advantages to patients prone to hypervolemia.
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