Artéria radial versus veia safena para revascularização do miocárdio: metanálise (não houve diferença estatisticamente significante)Radial artery versus saphenous vein to myocardial revascularization: meta-analysis (there is no statistically significant difference) AbstractObjective: To compare the effectiveness of the radial artery graft with the saphenous vein graft for myocardial revascularization in association with the internal thoracic artery.Methods: A systematic review of the literature was made, searching for articles in the MEDLINE and LILACS databases. Two independent researchers performed the selection of articles, carefully evaluating the methodology described in articles considered relevant to the subject. Only controlled trials with an adequate randomization system were included. In all situations, when the researchers did not reach an agreement, a consensus meeting was held. No restrictions were stipulated in respect to the follow-up period for the angiographic evaluation of the graft, the vessel treated or the characteristics of the patients included in the studies. The results are expressed as Relative Risks (RR), with 95% Confidence Intervals (CI) to compare the effectiveness between the radial artery and the saphenous vein.Results: Based on these criteria, three studies were included. We did not find statistical differences between the patencies of the grafts (RR 0.53 [95% IC 0. -2.18]).Conclusion: Despite the studies having good methodologies we did not observe statistically significant differences between the grafts. The statistical power of the meta-analysis is low and therefore, more randomized controlled trials are necessary, with adequate sample sizes to detect possible differences between the different treatments.Descriptors: Radial artery. Saphenous vein. Myocardial revascularization. Meta-analysis. 256LOCALI, RF ET AL -Radial artery versus saphenous vein to myocardial revascularization: meta-analysis (there is no statistically significant difference) Braz J Cardiovasc Surg 2006; 21(3): 255-261
RBCCV 44205-845Uso da aprotinina na operação da aorta torácica associada à hipotermia profunda e parada circulatória: metanálise Use of aprotinin in thoracic aortic operations associated with deep hypothermic circulatory arrest: a meta-analysis Abstract Objective: To evaluate complications involved in the use of aprotinin in patients after thoracic aortic aneurysm or dissection surgeries associated with deep hypothermic circulatory arrest.Methods: A systematic review of literature was carried out, with a search strategy of low specificity, in the Medline ® and LILACS ® databases. Two independent researchers carried out article selection following the criteria adopted for inclusion of studies, grouping them into two groups, one where low doses of aprotinin were employed and the other with high doses. The results are presented as relative risk for the dichotomy variable, and as weighted mean differences for continuous variables, both with 95% confidence intervals.Results: Seven articles were included in the systematic review selected from 2044 revised studies. Meta-analysis of the only randomized controlled trial did not demonstrate risks with the use of aprotinin, and presented a significant reduction in bleeding and blood transfusion requirements. Meta-analysis of the studies that used low doses of aprotinin was similar. On the other hand, meta-analysis of the studies that adopted high doses of aprotinin did not present statistical significance in any of the studied variables.Conclusion: Despite of the results not showing any effective risks with the use of aprotinin, the statistical power of the meta-analysis is low. Therefore, new randomized controlled trials are required, in order to detect possible complications in the use of aprotinin in this type of operation.Descriptors: Aprotinin. Aorta thoracic. Hypothermia induced. Meta-analysis. 378LOCALI, RF ET AL -Use of aprotinin in thoracic aortic operations associated with deep hypothermic circulatory arrest: a meta-analysis Braz J Cardiovasc Surg 2006; 21(4): 377-385 INTRODUCTIONThe conventional surgical treatment of aneurysms or dissections of the ascending or transverse aorta is indispensable to guarantee a satisfactory prognosis of the patient. It is well known that this procedure is associated with high morbimortality rates. Thus, in order to reduce the intra-operative risks, it is necessary to establish cardiopulmonary bypasses (CPB) and deep hypothermia with circulatory arrest (DHCA) [1,2]. However, it is also well known that the combination of CPB with DHCA may contribute to a greater risk of complications of the surgical procedure by triggering hemostatic dysfunction and coagulopathies [2,3].Coagulopathies triggered by CPB have a multifactorial origin although its primary cause is exposure of the blood to the materials of the heart-lung machine [4]. Additionally, the administration of heparin and protamine cause alterations to the hemostatic balance by activation of the platelets, neutrophils and of the fibrinolytic system as well as consuming coagul...
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