Use of standard del nido cardioplegia for the intracardiac repair of tetralogy of Fallot: A systematic review and meta-analysis of randomized controlled trials

This meta-analysis compares the efficacy of the standard Del Nido cardioplegia with other agents during intra-cardiac tetralogy of Fallot repair. Meta-analysis was performed on studies comparing standard Del Nido cardioplegia with other types of cardioplegia. Outcomes were pooled using inverse variance and random effects analysis models to calculate the standardized mean difference (SMD) and odds ratio (OR). The SMD for ICU length of stay, duration of mechanical ventilation, and time taken for the heart to return to normal rhythm were -0.06 (P=0.67), -0.21 (P=0.06), and 0.23 (P=0.48), respectively. The OR for the incidence of postoperative arrhythmias was 0.65 (P=0.32). The standardized mean differences for twenty-four-hour post-operative IL-6, TNF-α, and cTnI levels were 0.29 (P=0.16), -0.27 (P=0.01), and -0.60 (P=0.01), respectively. Del Nido cardioplegia is protective on the myocardium, with lower levels of inflammatory cytokines 24 hours post-operation and a significantly reduced incidence of post-operative arrhythmias.