Objectives To compare biological versus mechanical aortic valve replacement. Methods We searched MEDLINE, Scopus, and Cochrane Library databases for randomized clinical trials and propensity-score matched studies published by October 14th, 2021 according to PRISMA statement. Individual patient data on overall survival were extracted. One- and two-stage survival analyses, and random-effects meta-analyses were conducted Results 25 studies were identified, incorporating 8,721 bioprosthetic and 8,962 mechanical valves:. In the one-stage meta-analysis, mechanical valves cumulatively demonstrated decreased hazard for mortality (Hazard Ratio [HR] : 0.79, 95% Confidence interval [CI] : 0.74–0.84, p < 0.0001). Overall survival was similar between the compared arms for patients <50 years old (HR: 0.88, 95% CI : 0.71–1.1, p = 0.216), increased in the mechanical valve arm for patients 50–70 years old (HR : 0.76, 95% CI : 0.70–0.83, p < 0.0001), and increased in the bioprosthetic arm for patients >70 years old (HR : 1.35, 95% CI : 1.17–1.57, p < 0.0001). Meta-regression analysis revealed that the survival in the 50–70 years old group was not influenced by the publication year of the individual studies. No statistically significant difference was observed regarding in-hospital mortality, post-operative strokes and post-operative reoperation. All-cause mortality was found decreased in the mechanical group, cardiac mortality was comparable between the two groups, major bleeding rates were increased in the mechanical valve group, and reoperation rates were increased in the bioprosthetic valve group. Conclusions Survival rates seem to not be influenced by the type of prosthesis in patients <50 years old. A survival advantage in favour of mechanical valves is observed in patients 50–70 years old, while in patients >70 years old bioprosthetic valves offer better survival outcomes.
Objectives: The aim of the study is to compare the safety and efficacy of unilateral anterograde cerebral perfusion (UACP) and bilateral anterograde cerebral perfusion (BACP) for acute type A aortic dissection (ATAAD). Methods: A systematic review of the MEDLINE (PubMed), Scopus, and Cochrane Library databases (last search: August 7th, 2021) was performed according to the PRISMA statement. Studies directly comparing UACP versus BACP for ATAAD were included. Random-effects meta-analyses were performed. Results: Eight retrospective cohort studies were identified, incorporating 2416 patients (UACP: 843, BACP: 1573). No statistically significant difference was observed regarding in-hospital mortality (odds ratio [OR]:1.05 [95% Confidence Interval (95% CI):0.70–1.57]), permanent neurological deficit (PND) (OR: 0.94 [95% CI: 0.52–1.70]), transient neurological deficit (TND) (OR: 1.37 [95% CI: 0.98–1.92]), renal failure (OR: 0.96 [95% CI: 0.70–1.32]), and re-exploration for bleeding (OR: 0.77 [95% CI: 0.48–1.22]). Meta-regression analysis revealed that PND and TND were not influenced by differences in rates of total arch repair, Bentall procedure, and concomitant CABG in UACP and BACP groups. Cardiopulmonary bypass time (Standard Mean Difference [SMD]: −0.11 [95% CI: −0.22, 0.44]), Cross clamp time (SMD: −0.04 [95% CI: −0.38, 0.29]), and hypothermic circulatory arrest time (SMD: −0.12 [95% CI: −0.55, 0.30]) were comparable between UACP and BACP. Intensive care unit stay was shorter in BACP arm (SMD:0.16 [95% CI: 0.01, 0.31]); however, length of hospital stay was shorter in UACP arm (SMD: −0.25 [95% CI: −0.45, −0.06]). Conclusions: UACP and BACP had similar results in terms of in-hospital mortality, PND, TND, renal failure, and re-exploration for bleeding rate in patients with ATAAD. ICU stay was shorter in the BACP arm while LOS was shorter in the UACP arm.
Objectives: The aim of the study is to compare the safety and efficacy of unilateral anterograde cerebral perfusion (UACP) and bilateral anterograde cerebral perfusion (BACP) for acute type A aortic dissection (ATAAD). Methods: A systematic review of MEDLINE (PubMed), Scopus, and Cochrane Library databases (last search: August 7 , 2021) was performed according to the PRISMA statement. Studies directly comparing UACP versus BACP for ATAAD were included. Random-effects meta-analyses were performed. Results: Eight retrospective cohort studies were identified, incorporating 2416 patients (UACP: 843, BACP: 1573). No statistically significant difference was observed regarding in-hospital mortality (odds ratio [OR]:1.05 [95% Confidence Interval (95%CI):0.70-1.57]), permanent neurological deficit (PND) (OR: 0.94 [95%CI:0.52-1.70]), transient neurological deficit (TND) (OR: 1.37 [95%CI:0.98-1.92]), renal failure (OR: 0.96 [95%CI:0.70-1.32]), and re-exploration for bleeding (OR: 0.77 [95%CI:0.48-1.22]). Meta-regression analysis revealed that PND and TND were not influenced by differences in rates of total arch repair, Bentall procedure and concomitant CABG in UACP and BACP groups. Cardiopulmonary bypass time (Standard Mean Difference [SMD]:-0.11 [95%CI:-0.22, 0.44]), Cross clamp time (SMD:-0.04 [95%CI:-0.38, 0.29]) and hypothermic circulatory arrest time (SMD:-0.12 [95%CI:-0.55, 0.30]) were comparable between UACP and BACP. Intensive care unit stay was shorter in BACP arm (SMD:0.16 [95%CI:0.01, 0.31]), however, length of hospital stay was shorter in UACP arm (SMD:-0.25 [95%CI:-0.45, -0.06]). Conclusions: UACP and BACP had similar results in terms of in-hospital mortality, PND, TND, renal failure and re-exploration for bleeding rate in patients with ATAAD. ICU stay was shorter in the BACP arm while LOS was shorter in the UACP arm.
Objective: The aim of this study is to compare the outcomes after implementation of piezoelectric bone surgery versus conventional rotatory devices in sinus lift surgery. Methods: A systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database was performed (last search date: 04 March 2022) according to the PRISMA guidelines. Only randomized controlled trials that directly compare the two techniques were included. Random-effects model meta-analysis were performed. Results: Six studies, comprising a total of 140 patients/ 259 sinuses, 130 undergoing sinus lift with piezoelectric osteotomy device and 129 with conventional rotatory burs were identified and five of them were included in our meta-analysis. The two techniques were compared for intraoperative membrane perforation and operative time. No statistically significant difference was observed regarding membrane perforation (Standardized Mean Difference [SMD]: 0.87, 95% Confidence Interval [CI]: [0.33] – [2.28], p=0.78, I2= 0.00%) and operative time (SMD: 0.76, 95% CI: [-0.09] – [1.60], p=0.08, I2=77.70%). Conclusions: Data seem to agree that both piezoelectric osteotomy and osteotomy with conventional rotatory burs have similar results in membrane perforation and operative time when used for sinus lift surgery.
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