Background: There is no consensus on the role of beating heart coronary artery bypass graft surgery (BECAB) in adult Bangladeshi patients requiring coronary revascularization surgery. We aimed to conduct a systematic review on all literature related to BECAB and/or conventional (CCAB) to determine the comparability of the patient outcomes of BECAB with that of a controlled cohort.
Method: We carried out a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A meta-analysis was conducted to compare clinical outcomes between the BECAB and CCAB cohorts. Pooled analyses were also performed to determine the incidence rates of any adverse outcomes related to CABG.
Results: We observed significantly lower rates of operation time (MD: -52.30, CI: -67.73 to -36.86, p<0.0001), ventilation time (MD: -8.64, CI: -9.47 to -7.82, p<0.0001) and ICU stay (MD: -17.47, CI: -33.57 to -1.38, p=0.03) associated with BECAB. From our pooled analyses of the BECAB cohort, we observed that the average blood loss was 500.303 [352.099, 648.507], while the average rates of perioperative MI (0.020 [0.002, 0.049]), stroke/TIA (0.015 [0.000, 0.042]), AKI (0.006 [0.002, 0.012]), respiratory complications (0.020 [0.000, 0.058]) and low output syndrome (0.123 [0.106, 0.141]) were all lower than the averages observed in the CCAB cohort.
Conclusion: In an adult Bangladeshi CABG population, the clinical outcomes of patients that underwent BECAB were non-inferior to, if not better than, patients who underwent CCAB.
Bangladesh Heart Journal 2020; 35(2) : 87-99
Background:
The development of atrioventricular bioprosthesis has witnessed an increasing drive toward clinical translation over the last few decades. A significant challenge in the clinical translation of an atrioventricular bioprosthesis from bench to bedside is the appropriate choice of a large animal model to test the safety and effectiveness of the device.
Methods:
We conducted a systematic review of preclinical in vivo studies that would enable us to synthesize a recommended framework. PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines were followed to identify and extract relevant articles.
Results:
Sheep was the most common choice of animal, with nine out of the 12 included studies being conducted on sheep. There were acute and chronic studies based on our search criteria. An average of ~20 and 5 animals were used for chronic and acute studies. One out of three acute studies and eight out of nine chronic studies were on stented heart valve bioprosthesis. All analyses were conducted on the implantation of atrioventricular valves with trileaflet, except for one chronic study on unileaflet valves and one chronic and acute study on bileaflet valves.
Conclusion:
Understanding the variance in past preclinical study designs may increase the appropriate utilization of large animal models. This synthesized evidence provides a preclinical Invivo studies framework for future research with an atrioventricular bioprosthesis.
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