Postoperative air leak grading is useful to predict prolonged air leak after pulmonary lobectomy

Transcatheter aortic valve replacement (TAVR) has recently been approved for use in patients who are at intermediate and low surgical risk. Moreover, recent years have witnessed a renewed interest in minimally invasive aortic valve replacement (miAVR). The present meta-analysis compared the outcomes of TAVR and miAVR in the management of aortic stenosis (AS). We conducted an electronic search across six databases from 2002 (TAVR inception) to December 2019. Data from relevant studies regarding the clinical and length of hospitalisation outcomes were extracted and analysed using R software. We identified a total of 11 cohort studies, of which seven were matched/propensity matched. Our analysis demonstrated higher rates of midterm mortality (≥1 year) with TAVR (risk ratio (RR): 1.93, 95% CI: 1.16 to 3.22), but no significant differences with respect to 1 month mortality (RR: 1.00, 95% CI: 0.55 to 1.81), stroke (RR: 1.08, 95% CI: 0.40 to 2.87) and bleeding (RR: 1.45, 95% CI: 0.56 to 3.75) rates. Patients undergoing TAVR were more likely to experience paravalvular leakage (RR: 14.89, 95% CI: 6.89 to 32.16), yet less likely to suffer acute kidney injury (RR: 0.38, 95% CI: 0.21 to 0.69) compared with miAVR. The duration of hospitalisation was significantly longer in the miAVR group (mean difference: 1.92 (0.61 to 3.24)). Grading of Recommendations Assessment, Development and Evaluation assessment revealed ≤moderate quality of evidence in all outcomes. TAVR was associated with lower acute kidney injury rate and shorter length of hospitalisation, yet higher risks of midterm mortality and paravalvular leakage. Given the increasing adoption of both techniques, there is an urgent need for head-to-head randomised trials with adequate follow-up periods.

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“… 13 14 The adoption of sutureless or rapid deployment valves, however, has mitigated these concerns to some extent. 15 …”

Section: Introductionmentioning

confidence: 99%

Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis

et al. 2021

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“…Postoperative factors could be assessed for the timing of intervention after air leak. Okada et al (12) and Oh et al (16) emphasized the importance of quantifying air leakage in the postoperative period. Postoperative albumin, leukocyte, hemoglobin and three days postoperative drainage was not previously considered clinically relevant.…”

Section: Discussionmentioning

confidence: 99%

“…Prolonged air leak (PAL) is a condition where air escapes from the lung parenchyma into the pleural space for more than 5 days after lung surgery (1). PALs are considered to be the most common postoperative complication of the lung surgery with an incidence of 6-26% (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Previous studies have found that PAL is associated with other pulmonary complications such as atelectasis and pneumonia, which often translate into longer hospital stays and more hospitalization costs (18,19).…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with prolonged air leak after video-assisted thoracic surgery pulmonary resection: a predictive model and meta-analysis

et al. 2019

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Background: This study aimed to establish a predictive model for prolonged air leak (PAL) after videoassisted thoracic surgery (VATS) lung resection; and additionally, to present a meta-analysis of the relevant literature to estimate the association between various clinical factors and PAL. Methods: A retrospective, case-control study was conducted using univariate analysis and logistic regression based on 493 medical records from patients who underwent VATS lung resection between January 2015 and August 2017 at our institution. PAL was defined as air leak more than 5 days after lung surgery. Subsequently, a nomogram was established as a predictive model. Relevant studies were screened from PubMed, Embase and Cochrane for relevant studies and data was extracted from those enrolled. Pooled odds ratios or weighted mean differences with corresponding 95% confidence intervals were calculated to estimate the association between various clinical factors and PAL. Results: Incidence of PAL after VATS lung resection was observed in 54 (10.8%) of 493 patients. Logistic regression revealed that smoking (P=0.014), pulmonary function (P=0.011), pleural adhesion (P<0.001), stapling length (P<0.001), early postoperative drainage (P=0.002) were significantly associated with PAL. Our meta-analysis, including 17 eligible studies and 14 potential risk factors, further validating our findings. Upper lobectomy was determined to be a significant risk factor for PAL in Europeans and North Americans (OR =2.03, P<0.001), but not in Asians (OR =1.04, P=0.610). Importantly, the constructed nomogram demonstrated a good predictive ability (C-index =0.858). Conclusions: Lung stapling length and early postoperative drainage are important indicators for the evaluation of PAL occurrence. Upper pulmonary resection is a factor with particular regional differences as its association with PAL is not significant within Asian populations. Our nomogram, incorporating multiple factors, provided a simple and practical predictive model with value for clinical application.

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“…The majority of studies were conducted in Europe and the UK [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 32 , 34 , 35 , 36 , 37 , 38 , 40 , 46 , 47 , 49 , 52 , 56 , 57 , 58 , 60 , 61 , 66 , 68 , 72 , 73 , 75 , 84 , 92 ] followed by North America [ 15 , 17 , 19 , 21 , 29 , 31 , 33 , 39 , 43 , 45 , 48 , 54 , 55 , 64 , 67 , 69 , 71 , 76 , 77 , 78 , 79 , 83 , 86 , 88 , 89 , 90 ] and Asia. [ 14 , 16 , 18 , 20 , 41 , 44 , 50 , 51 , 53 , 62 , 63 , 65 , 74 , 80 ,…”

Section: Resultsmentioning

confidence: 99%

“…[ 14 , 52 , 65 , 77 , 86 ] 71.4% of studies did not include the post-intervention clinical condition of the patients and/or adverse or unanticipated events. [ 14 , 15 , 16 , 18 , 19 , 22 – 26 , 28 – 32 , 34 , 36 – 43 , 46 – 50 , 52 , 53 , 57 – 63 , 65 – 68 , 71 – 73 , 76 – 78 , 80 , 81 , 84 , 85 , 87 , 89 , 90 , 92 ]…”

Section: Resultsmentioning

confidence: 99%

Risk Factors and Patient Profile of Infective Endocarditis due to <i>Gemella spp.</i>

Kariyanna

Sutarjono²,

Ellanti

et al. 2020

AJMCR

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Background. The diagnosis of infective endocarditis is difficult, especially when it involves atypical organisms. Therefore, our study identified risk factors of infective endocarditis caused by rare pathogen, Gemella spp . Methods. A systematic review was conducted to investigate characteristics of endocarditis patients infected with Gemella spp. using the search term “ Gemella ” and “endocarditis.” Case reports were gathered by searching Medline/Pubmed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science databases. 83 articles were selected for review. Results. Five species of Gemella were identified. Typical patients were males between 31 and 45 years of age. On admission, patients had fever, tachycardia, and normal blood pressure. Common clinical manifestation other than fever included fatigue and weakness, chills and sweating, and nausea, vomiting, diarrhea, and weight changes. One in four reported a history of congenital heart disease, and a recent oral cavity infection. Laboratory tests reveal anemia, leukocytosis, and elevated erythrocyte sedimentation in all age groups, elevated C-reactive protein is observed among adult and geriatric populations only. Mitral and aortic valves were most commonly infected by Gemella spp. . The most common Gemella spp. -susceptible antibiotics were penicillin, vancomycin, cephalosporin, macrolide, and aminoglycosides. However, antibiotic resistance was observed against penicillin, aminoglycoside, and fluoroquinolone. Antibiotic course of at least six weeks resulted in superior clinical improvements than durations under six weeks. Finally, one in two patients underwent valve replacement or repair, with common complications affecting the cardiovascular, neurological, and renal systems. Finally, death occurred in 1 in 8 patients, half of which occurred post-surgical procedure, and the majority occurring equal to or greater than 1 week from admission. Conclusion. Our systematic review highlights the importance of considering rare pathogens, particularly in the presence of predisposing risk factors.

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Postoperative air leak grading is useful to predict prolonged air leak after pulmonary lobectomy

Cited by 23 publications

References 13 publications

Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis

Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis

Risk factors associated with prolonged air leak after video-assisted thoracic surgery pulmonary resection: a predictive model and meta-analysis

Risk Factors and Patient Profile of Infective Endocarditis due to <i>Gemella spp.</i>

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