Indian Journal of Thoracic and Cardiovascular Surgery | 2021
Impact of avoiding cardioplegic arrest on clinical outcome in patients undergoing CABG in Bangladesh: a systematic review and meta-analysis
Abstract
Over the last decade, the practice of surgical revascularization for the coronary artery disease has been popularized in Bangladesh. Our aim was to compare the outcome of non-cardioplegic versus cardioplegic coronary artery bypass surgery in terms of early postoperative outcomes. A literature search was conducted in March 2020 on Medline (via PubMed), Scopus and Bangladesh Journal Online electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All randomized controlled trials and observational studies reporting findings of coronary revascularization surgery comparing the outcomes were included. Fifteen studies were used quantitatively that included a total cohort of 4750 coronary artery bypass graft (CABG) patients in Bangladesh. After the meta-analysis, we observed a longer duration of operating time [mean difference (MD): −\u200952.30, confidence interval (CI): −\u200967.73 to −\u200936.86, I2 18\u2009=\u200989%, p\u2009<\u20090.00001] and a higher incidence of postoperative atrial fibrillation [risk ratio (RR): 0.43, CI: 0.14 to 0.80, I2\u2009=\u200944%, p\u2009=\u20090.01] in the cardioplegic CABG group as compared with the non-cardioplegic group. Additionally, statistically significant longer duration of ventilation time (MD: −\u20098.64, CI: −\u20099.47 to −\u20097.82, I2\u2009=\u200982%, p\u2009<\u20090.00001) and ICU stay (MD: −\u200917.25, CI: −\u200933.36 to −\u20091.14, I2\u2009=\u200999%, p\u2009=\u20090.04) was observed in the cardioplegic group. No significant differences in number of grafts and in-hospital mortality were found between the two groups. Non-cardioplegic CABG may be a viable alternative to cardioplegic CABG in Bangladeshi population, providing similar postoperative outcomes but offering additional advantage of shorter operation and ventilation times.