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Interactive Cardiovascular and Thoracic... Jan 2018Complete atrioventricular septal defect with tetralogy of Fallot is a rare congenital heart disease. The combination of these lesions occurs in about 1% of all patients... (Meta-Analysis)
Meta-Analysis Review
Influence of staged repair and primary repair on outcomes in patients with complete atrioventricular septal defect and tetralogy of Fallot: a systematic review and meta-analysis.
OBJECTIVES
Complete atrioventricular septal defect with tetralogy of Fallot is a rare congenital heart disease. The combination of these lesions occurs in about 1% of all patients with atrioventricular canal defects and in 5-6% of patients with tetralogy of Fallot. To assess the influence of surgical strategy on the survival and reintervention rate for the left atrioventricular valve and right ventricular outflow tract.
METHODS
We analyzed all related studies since 1986. Thirty-eight articles were initially retrieved via PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and Google Scholar, from which 18 retrospective studies were included in the systematic review and 8 studies in the meta-analysis.
RESULTS
There was no significant difference in the 6-year survival between staged repair and primary repair [80 patients in the primary group and 81 patients in the staged group; I2 = 0%; time-to-event data Peto odds ratio 0.66, 95% confidence interval (CI) 0.3-1.5, P = 0.31; hazard ratio 0.66, 95% CI 0.3-1.3, P = 0.23]. Both groups had an equal reintervention rate for the left atrioventricular valve [75 patients in the primary group and 71 patients in the staged group; I2 = 0.26%; the Mantel-Haenszel odds ratio 0.60, 95% CI 0.22-1.68, P = 0.33], but patients who received an initial palliation had a higher rate of reoperation on the right ventricular outflow tract [I2 = 0%; the Mantel-Haenszel odds ratio 0.27, 95% CI 0.27-0.9988, P = 0.05].
CONCLUSIONS
Results of this meta-analysis reveal no difference in 6-year survival and reoperation rate for the left atrioventricular valve; however, patients who underwent staged repair had a higher rate of reintervention for the right ventricular outflow tract, which could be related to initially poor pulmonary bed anatomy. Therefore, both the primary repair and the staged repair are acceptable options for repair of complete atrioventricular septal defect with tetralogy of Fallot. The choice of surgical strategy must consider the anatomy of the pulmonary bed, patient condition and associated anomalies, which could affect surgical risk.
Topics: Abnormalities, Multiple; Cardiac Surgical Procedures; Child; Heart Septal Defects; Humans; Palliative Care; Tetralogy of Fallot; Treatment Outcome
PubMed: 29049707
DOI: 10.1093/icvts/ivx267 -
Current Problems in Cardiology Jan 2023Transcutaneous aortic valve implantation (TAVI) has transformed the management of aortic stenosis (AS) and is increasingly being used for patients with symptomatic,... (Meta-Analysis)
Meta-Analysis Review
Transcutaneous aortic valve implantation (TAVI) has transformed the management of aortic stenosis (AS) and is increasingly being used for patients with symptomatic, severe aortic stenosis who are ineligible or at high risk for conventional cardiac surgery. PUBMED, Google Scholar, and SCOPUS databases were searched to identify studies reporting heart failure hospitalization after TAVI. Major factors evaluated for HF hospitalization were age, comorbidities such as hypertension, atrial fibrillation (AF), chronic pulmonary disease including COPD, chronic kidney disease, baseline LVEF before the procedure, NYHA symptom class, and society of thoracic surgeons (STS) score. Hazard ratio (HR) with a 95% confidence interval were computed using random-effects models. A total of eight studies were included comprising 77,745 patients who underwent TAVI for severe aortic stenosis. The presence of diabetes mellitus (HR: 1.39, 95% CI [1.17, 1.66], chronic kidney disease (CKD) (HR: 1.39, 95% CI [1.31, 1.48], atrial fibrillation (HR: 1.69, 95% CI [1.42, 2.01], chronic pulmonary disease (HR: 1.33, 95% CI [1.12, 1.58], and a high STS score (HR: 1.07, 95% CI [1.03, 1.11] were positive predictors of 1-year HF hospitalization after TAVI. Patients with diabetes mellitus, AF, CKD, chronic pulmonary disease, and a high STS score are at an increased risk of heart failure hospitalization at 1-year of TAVI, whereas increasing age, hypertension, LVEF <50%, and NYHA class III/IV symptoms did not predict HF hospitalization. Careful follow-up after TAVI in high-risk patients, with closer surveillance for HF particularly, is key to preventing HF hospitalizations and death.
Topics: Humans; Aortic Valve; Transcatheter Aortic Valve Replacement; Atrial Fibrillation; Patient Readmission; Risk Factors; Aortic Valve Stenosis; Heart Failure; Lung Diseases; Renal Insufficiency, Chronic; Hypertension; Treatment Outcome
PubMed: 36191693
DOI: 10.1016/j.cpcardiol.2022.101428 -
European Journal of Cardio-thoracic... Dec 2014There is controversy over the use of the Ross procedure with regard to the sub-coronary and root replacement technique and its long-term durability. A systematic review... (Review)
Review
There is controversy over the use of the Ross procedure with regard to the sub-coronary and root replacement technique and its long-term durability. A systematic review of the literature may provide insight into the outcomes of these two surgical subvariants. A systematic review of reports between 1967 and February 2013 on sub-coronary and root replacement Ross procedures was undertaken. Twenty-four articles were included and divided into (i) sub-coronary technique and (ii) root replacement technique. The 10-year survival rate for a mixed-patient population in the sub-coronary procedure was 87.3% with a 95% confidence interval (CI) of 79.7-93.4 and 89.1% (95% CI, 85.3-92.1) in the root replacement technique category. For adults, it was 94 vs 95.3% (CI, 88.9-98.1) and in the paediatric series it was 90 vs 92.7% (CI, 86.9-96.0), respectively. Freedom from reoperation at 10 years was, in the mixed population, 83.3% (95% CI, 69.9-93.4) and 93.3% (95% CI, 89.4-95.9) for sub-coronary versus root replacement technique, respectively. In adults, it was 98 vs 91.2% (95% CI, 82.4-295.8), and in the paediatric series 93.3 vs 92.0% (95% CI, 86.1-96.5) for sub-coronary versus root replacement technique, respectively. The Ross procedure arguably has satisfactory results over 5 and 10 years for both adults and children. The results do not support the advantages of the sub-coronary technique over the root replacement technique. Root replacement was of benefit to patients undergoing reoperations on neoaorta and for long-term survival in mixed series.
Topics: Adult; Aortic Valve; Female; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Pulmonary Valve; Reoperation; Survival Analysis
PubMed: 24771757
DOI: 10.1093/ejcts/ezu176 -
Journal of Chemotherapy (Florence,... Sep 2021Infective Endocarditis (IE) carries significant mortality. Bacteremia, which is a predisposing factor for IE, occurs more frequently in immunocompromised individuals....
Infective Endocarditis (IE) carries significant mortality. Bacteremia, which is a predisposing factor for IE, occurs more frequently in immunocompromised individuals. Interestingly, IE in kidney transplant recipients has not been adequately described. The aim of this study was to systematically review all published cases of IE in kidney transplant recipients and describe their epidemiology, microbiology, clinical characteristics, treatment and outcomes. A systematic review of PubMed (through 13 December 2019) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of IE in kidney transplant recipients was performed. A total of 60 studies, containing data of 117 patients, were included in the analysis. The most common causative pathogens were gram-positive microorganisms in 57.4%, gram-negative microorganisms in 14.8%, fungi in 20%, while in 18.9% of cases, IE was culture-negative. Aortic valve was the most commonly infected valve followed by mitral, tricuspid and the pulmonary valve. Diagnosis was set with a transthoracic ultrasound in half the cases, followed by transesophageal ultrasound and autopsy. Fever was present in most cases, while embolic phenomena were noted in two out of five cases. Aminoglycosides, cephalosporins and aminopenicillins were the most commonly used antimicrobials, and surgical management was performed in one out of three cases. Clinical cure was noted in 60.9%, while overall mortality was 45.3%. To conclude, this systematic review thoroughly describes IE in kidney transplant recipients and provides information on epidemiology, clinical presentation, treatment and outcomes. Moreover, it identifies the emerging role of , gram-negatives and fungi in IE in this population.
Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Endocarditis; Endocarditis, Bacterial; Female; Humans; Immunocompromised Host; Kidney Transplantation; Male; Middle Aged; Time Factors; Young Adult
PubMed: 33327869
DOI: 10.1080/1120009X.2020.1861512 -
Journal of Clinical Medicine Jul 2023Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The...
Infective Endocarditis Risk with Melody versus Sapien Valves Following Transcatheter Pulmonary Valve Implantation: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.
BACKGROUND
Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The Medtronic Melody and the Edwards Sapien are the two valves approved for use in TPVI. Since TPVI patients are typically younger, even a modest annual incidence of infective endocarditis (IE) is significant. Several previous studies have shown a growing risk of IE after TPVI. There is uncertainty regarding the overall incidence of IE and differences in the risk of IE between the valves.
METHODS
A systematic search was conducted in the MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to 1 January 2023 using the search terms 'pulmonary valve implantation', 'TPVI', or 'PPVI'. The primary outcome was the pooled incidence of IE following TPVI in Melody and Sapien valves and the difference in incidence between Sapien and Melody valves. Fixed effect and random effect models were used depending on the valve. Meta-regression with random effects was conducted to test the difference in the incidence of IE between the two valves.
RESULTS
A total of 22 studies (including 10 Melody valve studies, 8 Sapien valve studies, and 4 studies that included both valves (572 patients that used the Sapien valve and 1395 patients that used the Melody valve)) were used for the final analysis. Zero IE incidence following TPVI was reported by eight studies (66.7%) that utilized Sapien valves compared to two studies (14.3%) that utilized Melody valves. The pooled incidence of IE following TPVI with Sapien valves was 2.1% (95% CI: 0.9% to 5.13%) compared to 8.5% (95% CI: 4.8% to 15.2%) following TPVI with Melody valves. Results of meta-regression indicated that the Sapien valve had a 79.6% (95% CI: 24.2% to 94.4%, = 0.019; R = 34.4) lower risk of IE incidence compared to the Melody valve.
CONCLUSIONS
The risk of IE following TPVI differs significantly. A prudent valve choice in favor of Sapien valves to lower the risk of post-TPVI endocarditis may be beneficial.
PubMed: 37568289
DOI: 10.3390/jcm12154886 -
Frontiers in Cardiovascular Medicine 2021Postoperative pulmonary complications remain a leading cause of increased morbidity, mortality, longer hospital stays, and increased costs after cardiac surgery;...
Comparative Evaluation of the Incidence of Postoperative Pulmonary Complications After Minimally Invasive Valve Surgery vs. Full Sternotomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Propensity Score-Matched Studies.
Postoperative pulmonary complications remain a leading cause of increased morbidity, mortality, longer hospital stays, and increased costs after cardiac surgery; therefore, our study aims to analyze whether minimally invasive valve surgery (MIVS) for both aortic and mitral valves can improve pulmonary function and reduce the incidence of postoperative pulmonary complications when compared with the full median sternotomy (FS) approach. A comprehensive systematic literature research was performed for studies comparing MIVS and FS up to February 2021. Randomized controlled trials (RCTs) and propensity score-matching (PSM) studies comparing early respiratory function and pulmonary complications after MIVS and FS were extracted and analyzed. Secondary outcomes included intra- and postoperative outcomes. A total of 10,194 patients from 30 studies (6 RCTs and 24 PSM studies) were analyzed. Early mortality differed significantly between the groups (MIVS 1.2 vs. FS 1.9%; = 0.005). Compared with FS, MIVS significantly lowered the incidence of postoperative pulmonary complications (odds ratio 0.79, 95% confidence interval [0.67, 0.93]; = 0.004) and improved early postoperative respiratory function status (mean difference -24.83 [-29.90, -19.76]; < 0.00001). Blood transfusion amount was significantly lower after MIVS ( < 0.02), whereas cardiopulmonary bypass time and aortic cross-clamp time were significantly longer after MIVS ( < 0.00001). Our study showed that minimally invasive valve surgery decreases the incidence of postoperative pulmonary complications and improves postoperative respiratory function status.
PubMed: 34497838
DOI: 10.3389/fcvm.2021.724178 -
Clinical Immunology (Orlando, Fla.) Nov 2023Antiphospholipid syndrome (APS) is a systemic autoimmune disease clinically associated with thrombotic and obstetric events. Additional manifestations have been...
Clinical features, risk factors, and outcomes of diffuse alveolar hemorrhage in antiphospholipid syndrome: A mixed-method approach combining a multicenter cohort with a systematic literature review.
BACKGROUND
Antiphospholipid syndrome (APS) is a systemic autoimmune disease clinically associated with thrombotic and obstetric events. Additional manifestations have been associated with APS, like diffuse alveolar hemorrhage (DAH). We aimed to summarize all the evidence available to describe the presenting clinical features, their prognostic factors, and short- and long-term outcomes.
METHODS
We performed a mixed-method approach combining a multicenter cohort with a systematic literature review (SLR) of patients with incident APS-associated DAH. We described their clinical features, treatments, prognostic factors, and outcomes (relapse, mortality, and requirement of mechanical ventilation [MV]). Kaplan-Meier methods were used to estimate relapse and mortality rates, and Cox and logistic regression models were used to assess the factors associated as appropriate.
RESULTS
We included 219 patients with incident APS-associated DAH (61 from Mayo Clinic and 158 from SLR). The median age was 39.5 years, 51% were female, 29% had systemic lupus erythematosus, and 34% presented with catastrophic APS (CAPS). 74% of patients had a history of thrombotic events, and 26% of women had a history of pregnancy morbidity; half of the patients had a history of thrombocytopenia, and a third had valvulopathy. Before DAH, 55% of the patients were anticoagulated. At DAH onset, 65% of patients presented hemoptysis. The relapse rate was 47% at six months and 52% at one year. Triple positivity (HR 4.22, 95% CI 1.14-15.59) was associated with relapse at six months. The estimated mortality at one and five years was 30.3% and 45.8%. Factors associated with mortality were severe thrombocytopenia (< 50 K/μL) (HR 3.10, 95% CI 1.39-6.92), valve vegetations (HR 3.22, 95% CI 1.14-9.07), CAPS (HR 3.80, 95% CI 1.84-7.87), and requirement of MV (HR 2.22, 95% CI 1.03-4.80). Forty-two percent of patients required MV on the incident DAH episode. Patients presenting with severe thrombocytopenia (OR 6.42, 95% CI 1.77-23.30) or CAPS (OR 4.30, 95% CI 1.65-11.16) were more likely to require MV.
CONCLUSION
APS-associated DAH is associated with high morbidity and mortality, particularly when presenting with triple positivity, thrombocytopenia, valvular involvement, and CAPS.
Topics: Humans; Female; Adult; Male; Antiphospholipid Syndrome; Hemorrhage; Lung Diseases; Lupus Erythematosus, Systemic; Leukopenia; Risk Factors; Recurrence; Thrombocytopenia; Retrospective Studies; Multicenter Studies as Topic
PubMed: 37722463
DOI: 10.1016/j.clim.2023.109775 -
The Annals of Thoracic Surgery Sep 2018This meta-analysis compares the early and late outcomes of valve repair versus replacement, the primary surgical strategies for tricuspid valve infective endocarditis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This meta-analysis compares the early and late outcomes of valve repair versus replacement, the primary surgical strategies for tricuspid valve infective endocarditis (IE).
METHODS
We searched MEDLINE and EMBASE databases until 2016 for studies comparing tricuspid valve repair and replacement.
RESULTS
The main outcomes were mortality, recurrent IE, and need for reoperation. There were 12 unmatched retrospective observational studies with 1,165 patients (median follow-up 3.8 years, interquartile range: 2.1 to 5.0). The most common indications for surgery were septic pulmonary embolism, left-sided IE, right-side heart failure, and persistent bacteremia. Median repair proportion was 59% and replacement was 41% among studies. The primary repair strategies are vegetectomy, De Vega procedure, annuloplasty ring, bicuspidization, and leaflet patch augmentation. Of valve replacements, 83% were bioprosthetic and 17% mechanical prostheses. There were no differences in perioperative mortality between tricuspid valve repair versus replacement (relative risk [RR] 0.62, 95% confidence interval [CI]: 0.26 to 1.46, p = 0.3). Long-term all-cause mortality was not different (RR 0.61, 95% CI: 0.22 to 1.72, p = 0.4). Valve repair was associated with lower recurrent IE (RR 0.17, 95% CI: 0.05 to 0.57, p = 0.004) and need for reoperation (RR 0.26, 95% CI: 0.07 to 0.92, p = 0.04) but a trend toward greater risk of moderate to severe tricuspid regurgitation (RR 4.14, 95% CI: 0.80 to 21.34, p = 0.09). Furthermore, tricuspid valve repair is associated with lower need for permanent pacemaker (RR 0.20, 95% CI: 0.11 to 0.35, p < 0.001).
CONCLUSIONS
Tricuspid valve repair and replacement offer similar long-term survival. Valve repair may offer greater freedom from recurrent IE and reoperation as well as freedom from pacemaker and should be the preferred approach for patients with tricuspid valve IE.
Topics: Adult; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prognosis; Proportional Hazards Models; Risk Assessment; Severity of Illness Index; Survival Analysis; Treatment Outcome; Tricuspid Valve Insufficiency
PubMed: 29750928
DOI: 10.1016/j.athoracsur.2018.04.012 -
The Annals of Thoracic Surgery Jun 2019As a living heart valve substitute with growth potential and improved durability, tissue-engineered heart valves (TEHVs) may prevent reinterventions that are currently... (Meta-Analysis)
Meta-Analysis
BACKGROUND
As a living heart valve substitute with growth potential and improved durability, tissue-engineered heart valves (TEHVs) may prevent reinterventions that are currently often needed in children with congenital heart disease. We performed early health technology assessment to assess the potential cost-effectiveness of TEHVs in children requiring right ventricular outflow tract reconstruction (RVOTR).
METHODS
A systematic review and meta-analysis was conducted of studies reporting clinical outcome after RVOTR with existing heart valve substitutes in children (mean age ≤12 years or maximum age ≤21 years) published between January 1, 2000, and May 2, 2018. Using a patient-level simulation model, costs and effects of RVOTR with TEHVs compared with existing heart valve substitutes were assessed from a health care perspective applying a 10-year time horizon. Improvements in performance of TEHVs, divided in durability, thrombogenicity, and infection resistance, were explored to estimate quality-adjusted life year (QALY) gain, cost reduction, headroom, and budget impact associated with TEHVs.
RESULTS
Five-year freedom from reintervention after RVOTR with existing heart valve substitutes was 46.1% in patients less than or equal to 2 years of age and 81.1% in patients greater than 2 years of age. Improvements in durability had the highest impact on QALYs and costs. In the improved TEHV performance scenario (durability ≥5 years and -50% other valve-related events), QALY gain was 0.074 and cost reduction was €10,378 per patient, translating to maximum additional costs of €11,856 per TEHV compared with existing heart valve substitutes.
CONCLUSIONS
This study showed that there is room for improvement in clinical outcomes in children requiring RVOTR. If TEHVs result in improved clinical outcomes, they are expected to be cost-effective compared with existing heart valve substitutes.
Topics: Adolescent; Child; Child, Preschool; Cost-Benefit Analysis; Humans; Infant; Pulmonary Valve; Tissue Engineering; Treatment Outcome; Young Adult
PubMed: 30605643
DOI: 10.1016/j.athoracsur.2018.11.066 -
Cardiovascular Revascularization... May 2022Aim of this study was to perform a systematic review a meta-analysis of the literature in order to identify predictors of acute kidney injury (AKI) in patients with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Aim of this study was to perform a systematic review a meta-analysis of the literature in order to identify predictors of acute kidney injury (AKI) in patients with mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair (TEER) and assess its effect on in-hospital outcomes and mortality. Although iodinated contrast is not typically used in TEER, these patients are still at risk for developing AKI.
METHODS
Studies reporting on the effect of incident AKI on mortality following TEER for MR were included. Random-effects meta-analysis was performed, comparing clinical outcomes between the patients with or without incident AKI.
RESULTS
Six studies including a total of 2057 patients (377 AKI and 1680 No-AKI) were included and analyzed. AKI was significantly associated with 30-day mortality after TEER (Odds ratio (OR): 8.06; 95% CI: 3.20, 20.30, p < 0.01; I = 18.4%) and all-cause mortality over a mean follow-up time of 30 months (Hazard ratio (HR): 2.48; 95% CI: 1.89, 3.24, p < 0.01; I = 23.7%). AKI after TEER was associated with prolonged hospitalization (Mean difference (in days): 1.41; 95% CI: 0.52, 2.31, p < 0.01; I = 82.4%). Stage 4 chronic kidney disease (CKD), device failure and history of chronic obstructive pulmonary disease (COPD) were significant predictors of AKI following TEER (CKD stage 4: OR: 2.38; 95% CI: 1.18, 4.78, p = 0.02; I = 0.0%; Device failure: OR: 3.15; 95% CI: 1.94, 5.12, p < 0.01; I = 0.0%; COPD: OR: 1.92; 95% CI: 1.16, 3.17; I = 26.7%).
CONCLUSIONS
Our findings highlight the renal vulnerability of the TEER population to renal injury and the associated deterioration in clinical outcomes and survival.
Topics: Acute Kidney Injury; Female; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Pulmonary Disease, Chronic Obstructive; Renal Insufficiency, Chronic; Treatment Outcome
PubMed: 34334337
DOI: 10.1016/j.carrev.2021.07.021