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Renal Failure Dec 2022Risk factors for acute kidney injury (AKI) after Stanford type A aortic dissection (TAAD) repair are inconsistent in different studies. This meta-analysis... (Meta-Analysis)
Meta-Analysis
Risk factors for acute kidney injury (AKI) after Stanford type A aortic dissection (TAAD) repair are inconsistent in different studies. This meta-analysis systematically analyzed the risk factors so as to early identify the therapeutic targets for preventing AKI. Studies exploring risk factors for AKI after TAAD repair were searched from four databases from inception to June 2022. The synthesized incidence and risk factors of AKI and its impact on mortality were calculated. Twenty studies comprising 8223 patients were included. The synthesized incidence of postoperative AKI was 50.7%. Risk factors for AKI included cardiopulmonary bypass (CPB) time >180 min [odds ratio (OR), 4.89, 95% confidence interval (CI), 2.06-11.61, = 0%], prolonged operative time (>7 h) (OR, 2.73, 95% CI, 1.95-3.82, = 0), advanced age (per 10 years) (OR, 1.34, 95% CI, 1.21-1.49, = 0], increased packed red blood cells (pRBCs) transfusion perioperatively (OR, 1.09, 95% CI, 1.07-1.11, = 42%), elevated body mass index (per 5 kg/m) (OR, 1.23, 95% CI, 1.18-1.28, = 42%) and preoperative kidney injury (OR, 3.61, 95% CI, 2.48-5.28, = 45%). All results were meta-analyzed using fixed-effects model finally ( < 0.01). The in-hospital or 30-day mortality was higher in patients with postoperative AKI than in that without AKI [risk ratio (RR), 3.12, 95% CI, 2.54-3.85, < 0.01]. AKI after TAAD repair increased the in-hospital or 30-day mortality. Reducing CPB time and pRBCs transfusion, especially in elderly or heavier weight patients, or patients with preoperative kidney injury were important to prevent AKI after TAAD repair surgery.
Topics: Acute Kidney Injury; Aged; Aortic Dissection; Child; Humans; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 36036431
DOI: 10.1080/0886022X.2022.2113795 -
International Journal of Cardiology Oct 2015Osteogenesis imperfecta (OI) is a rare, inherited systemic connective tissue disease that causes decreased bioavailability of collagen type 1. Collagen type 1 is the... (Review)
Review
INTRODUCTION
Osteogenesis imperfecta (OI) is a rare, inherited systemic connective tissue disease that causes decreased bioavailability of collagen type 1. Collagen type 1 is the most abundant connective tissue in the body and a key part of many organs. While the bone phenotype in OI is well described, less is known about the effects of decreased collagen on other organs. In the heart, collagen type 1 is present in the heart valves, chordae tendineae, annuli fibrosi and the interventricular septum. It is thus likely that the heart is affected in OI.
OBJECTIVES
The aim of this systematic literature review was to investigate whether patients with OI have an increased risk of cardiovascular disease compared to healthy adults.
DATA SOURCES
PubMed, Embase and key scientific meetings were searched for publications fulfilling the inclusion criteria.
STUDY SELECTION
Studies were selected if at least one patient with OI was described as having cardiovascular disease. The articles should be written in English, French, Italian, Spanish, German, Norwegian or Danish or have an English abstract.
DATA EXTRACTION
Data were extracted by HA, FTJ and LF using a predefined protocol.
RESULTS
A total of 68 studies were included in the review, comprising 51 case reports, 8 small case series (n<10 patients), 4 large case series (n ≥ 10 patients) and 5 cross-sectional studies comparing patients and controls. Together, the papers comprised 499 patients and covered 45 years of medical literature. The most commonly reported heart diseases amongst the patients with OI were valvulopathies and increased aortic diameter. Findings in the large case series and the cross-sectional studies were broadly similar to each other.
CONCLUSION
The findings support the hypothesis that patients with OI have increased risk of heart disease compared to healthy controls. It is biologically plausible that patients with OI may have an increased risk of developing heart disease, and valve disease in particular.
Topics: Heart Valve Diseases; Humans; Osteogenesis Imperfecta; Risk Factors
PubMed: 26100571
DOI: 10.1016/j.ijcard.2015.06.001 -
Ultrasound in Obstetrics & Gynecology :... Sep 2015The primary objective was to estimate the prevalence of aberrant right subclavian artery (ARSA) in fetuses with Down syndrome. Secondary objectives were to assess the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The primary objective was to estimate the prevalence of aberrant right subclavian artery (ARSA) in fetuses with Down syndrome. Secondary objectives were to assess the prevalence of ARSA in euploid fetuses, the feasibility of ultrasound evaluation of the right subclavian artery (RSA) in the first and second trimesters of pregnancy, the performance of ARSA in screening for trisomy 21 and its association with other abnormalities.
METHODS
Web-based databases (PubMed, EMBASE and MEDLINE) were searched up to July 2014. The STROBE, PRISMA and QUIPS instruments were used to assess all included studies and for reporting of methodology, results and conclusions. Original studies that reported prenatal ultrasound evaluation of ARSA, assessment of its prevalence in Down-syndrome and euploid fetuses, feasibility of ultrasound evaluation of the RSA in the first and second trimesters of pregnancy and correlation of ARSA with other abnormalities were included, excluding duplications and case reports. Collected data were summarized to estimate prevalence and feasibility. A meta-analysis was performed pooling the study-specific positive and negative likelihood ratios (LR+ and LR-), detection rates and false-positive rates for trisomy 21.
RESULTS
Prevalence of ARSA in Down-syndrome fetuses was 23.6% (95% CI, 19.4-27.9%), whereas in euploid fetuses it was 1.02% (95% CI, 0.86-1.10%). Ultrasound evaluation of the RSA course and origin in the first and second trimesters of pregnancy was feasible in 85% and 98% of cases (first and second trimester, respectively) and it was directly related to sonographic experience and fetal crown-rump length and inversely related to maternal body mass index. In more than 20% of fetuses with ARSA there was an association with other abnormalities but ARSA seemed to be an independent marker of trisomy 21. The meta-analysis showed that ARSA is a significant risk factor for Down syndrome (pooled LR+ = 26.93, 95% CI, 19.36-37.47, P for effect < 0.001, P for Q = 0.3, I(2) = 17.3%), whereas normal RSA is a significant protective marker (pooled LR- = 0.71, 95% CI, 0.51-0.99, P for effect = 0.043, P for Q = 0.9, I(2) = 0%).
CONCLUSIONS
ARSA appears to be a clinically useful prenatal ultrasound marker of Down syndrome. Additional testing when ARSA is diagnosed should involve evaluation of all risk factors by applying a mathematical model. There is insufficient evidence to recommend fetal karyotyping in cases with isolated ARSA. If the background risk is higher or additional markers are present, full fetal karyotyping is advisable, including analysis for 22q11 microdeletion.
Topics: Aneurysm; Cardiovascular Abnormalities; Deglutition Disorders; Down Syndrome; Female; Humans; Models, Statistical; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prevalence; Subclavian Artery; Ultrasonography, Prenatal
PubMed: 25586729
DOI: 10.1002/uog.14774 -
PloS One 2017Transcatheter aortic valve implantation (TAVI) has been demonstrated to be an alternative treatment for severe aortic stenosis in patients considered as high surgical... (Review)
Review
INTRODUCTION
Transcatheter aortic valve implantation (TAVI) has been demonstrated to be an alternative treatment for severe aortic stenosis in patients considered as high surgical risk. Since its first human implantation by Cribier et al., TAVI has been shown to increase survival rate and quality of life for high surgical risks patients. The objective of this study is to provide an overview of TAVI registries and the reporting clinical outcomes based on the VARC-2 definitions. In addition, the comparability and adherence of VARC-2 reporting within the identified TAVI registries was reviewed.
MATERIALS AND METHODS
A systematic review of TAVI registries reporting VARC-2 definitions has been performed in line with PRISMA guidelines in PubMed, ScienceDirect, Scopus databases and EMBASE. Based on VARC-2, patients' characteristics and procedure characteristics, 30-day clinical outcomes, 1-year mortality and composited endpoints were extracted from each registry's publications.
RESULTS
This review identified 466 studies that were potentially relevant, and 20 TAVI registries reported VARC-2 definitions involved in our present review. Of all 20 registries, an overall sample size of 12,583 patients was involved. The 30-day all-cause mortality ranged from 0 to 12.7%. From 20 registries, 14 registries reported the cardiovascular mortality at 30 days. 9 registries reported myocardial infarction (MI) rate based on VARC-2 definitions, and 7 registries reported peri-procedural MI rate (<72h). In our review, most of registries presented MI rates ranging from 0.5% to 2%. The majority of registries have reported complications such as bleeding, vascular complications and new pacemaker implantation.
CONCLUSION
Since the introduction of VARC definitions from 2011, VARC and VARC-2 definitions are still not systematically used by all TAVI studies. These endpoint definitions warrant a concise and systemic analysis of outcome measures. Reporting TAVI-outcome uniformly makes study result comparison feasible. This definitely will increase patient safety, additionally to provide sufficient evidence to support decision makers like regulatory bodies, HTA agencies, payers.
Topics: Aortic Valve Stenosis; Decision Support Techniques; Female; Guideline Adherence; Humans; Male; Quality of Life; Registries; Sample Size; Survival Analysis; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 28910289
DOI: 10.1371/journal.pone.0180815 -
Autoimmunity Reviews Sep 2019Immunoglobulin G4 (IgG4)-related disease is a systemic chronic fibroinflammatory disease that can affect almost every organ of the body. IgG4-related...
OBJECTIVE
Immunoglobulin G4 (IgG4)-related disease is a systemic chronic fibroinflammatory disease that can affect almost every organ of the body. IgG4-related periaortitis/periarteritis is a newly recognized subset of IgG4-related disease, and its characteristics and prognosis remain unclear. We investigated the clinical characteristics and prognosis of IgG4-related periaortitis/periarteritis.
METHODS
We performed a systematic literature review of IgG4-related periaortitis/periarteritis. Additionally, we have summarized the characteristics and prognosis of IgG4-related coronary arteritis.
RESULTS
We investigated 248 patients with IgG4-related periaortitis/periarteritis. All studies reported the condition in elderly patients, and male predominance was observed. The infra-renal abdominal aorta and iliac arteries were the most commonly affected sites. Most reports showed the serum C-reactive protein elevation in this disease entity, in contrast to non-vascular IgG4-related disease. Based on radiological findings observed in 27 patients with IgG4-related coronary arteritis, vasculitic lesions were classified into 3 types: stenotic (67% of patients), aneurysmal (42%), and diffuse wall thickening type (92%). Serum IgG4 level, but not C-reactive protein level, was associated with the number of affected organs in IgG4-related coronary arteritis. Corticosteroid treatment with or without cardiac surgery or percutaneous coronary intervention was effective in most patients with IgG4-related coronary arteritis; however, 33% of patients showed an unfavorable clinical course including disease progression, relapse, or death. Pre-treatment stenosis and/or aneurysms were associated with progression of stenosis or aneurysm after corticosteroid treatment.
CONCLUSION
Most clinical characteristics were similar between the IgG4-related periaortitis/periarteritis and the non-vascular IgG4-related disease groups; however, serum C-reactive protein level elevation was observed only in the former. Although corticosteroid treatment was effective, this disease can be life-threatening secondary to myocardial infarction, aortic dissection, and aneurysmal rupture. Pre-treatment evaluation of stenosis or aneurysms is important for predicting progression of stenosis or aneurysm after corticosteroid treatment.
Topics: Age Factors; Aged; Aged, 80 and over; Arteritis; Disease Progression; Female; Humans; Immunoglobulin G; Immunoglobulin G4-Related Disease; Male; Prognosis; Recurrence; Retroperitoneal Fibrosis; Sex Factors
PubMed: 31323364
DOI: 10.1016/j.autrev.2019.102354 -
Future Cardiology Mar 2023This systematic review aimed to shed light on the efficacy of intracoronary (IC) nicardipine in treating no reflow with CAD undergoing revascularization. Literature... (Review)
Review
This systematic review aimed to shed light on the efficacy of intracoronary (IC) nicardipine in treating no reflow with CAD undergoing revascularization. Literature search was performed on databases with following eligibility criteria: adult patients with CAD; clinical trials or observational studies; IC nicardipine as intervention; therapeutic and safety outcome reported. A total of 1249 papers were yielded during the literature search. Of these, 11 studies were finalized for this systematic review. Complete restoration of TIMI 3 flow was observed in 98.6% of the patients receiving IC nicardipine. A significant increase in the CBF after infusion of IC nicardipine (p < 0.05) was also observed. IC nicardipine significantly increases CBF and decreases coronary vascular resistance.
Topics: Adult; Humans; Coronary Artery Disease; Nicardipine; Coronary Circulation; Angioplasty, Balloon, Coronary; Treatment Outcome; Percutaneous Coronary Intervention
PubMed: 37264944
DOI: 10.2217/fca-2022-0085 -
Vascular Oct 2020Endovascular aneurysm repair has gained field over open surgery for the treatment of abdominal aortic aneurysm. However, type Ia endoleak represents a common... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Endovascular aneurysm repair has gained field over open surgery for the treatment of abdominal aortic aneurysm. However, type Ia endoleak represents a common complication especially in hostile neck anatomy that is recently faced using endoanchors. We conducted a systematic review and meta-analysis to collect and analyse all the available comparative evidence on the outcomes of the endosuture aneurysm repair in patients with or without hostile neck in standard endovascular aneurysm repair.
METHODS
The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the prospective and retrospective studies reporting primary use of the Heli-FX EndoAnchor implants were considered eligible for inclusion in this study. The main study outcomes (technical success of endoanchor implantation, incidence of type Ia endoleak, aortic stent graft migration and the percentage of patients who presented regression or expansion of aneurysm sac throughout the follow-up) were subsequently expressed as proportions and 95% confidence intervals.
RESULTS
Eight studies with a total of 968 patients were included in a pooled analysis. The technical success of the primary endoanchor fixation was 97.12% (95%CI: 92.98-99.67). During a mean six months follow-up period, a pooled rate of 6.23% (95%CI: 0.83-15.25) of the patients developed a persistent type Ia endoleak despite the primary implantation. Migration of the main graft was reported in five studies, in which a 0.26% (95%CI = 0.00-1.54) of the patients required an additional proximal aortic cuff. Regression of the aneurysm sac was observed at 68.82% (95%CI: 51.02-84.21). An expansion of the aneurysm sac was found in 1.93% (95%CI: 0.91-3.24) of the participants. The overall survival rate was 93.43% (95%CI: 89.97-96.29) at a mean six months follow-up period.
CONCLUSIONS
Endosuture aneurysm repair with the Heli-FX EndoAnchor implants seems to be technically feasible and safe either for prevention or for repair of intraoperative type Ia endoleak. Despite the primary implants of endoanchors, few cases of persistent type Ia endoleak and migration are still conspicuous. Long-term follow up is needed to determinate the role of this therapeutic option in the treatment of aortic aneurysms.
Topics: Aged; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endoleak; Endovascular Procedures; Female; Foreign-Body Migration; Humans; Male; Prosthesis Design; Risk Factors; Suture Techniques; Time Factors; Treatment Outcome
PubMed: 32390560
DOI: 10.1177/1708538120923417 -
VASA. Zeitschrift Fur Gefasskrankheiten Apr 2020The study objective was to evaluate the ability of computed tomography (CT) to identify technical complications intra-operatively during endovascular aneurysm repair... (Meta-Analysis)
Meta-Analysis
UNLABELLED
The study objective was to evaluate the ability of computed tomography (CT) to identify technical complications intra-operatively during endovascular aneurysm repair (EVAR). Frequency of complications seen by CT and their sequelae was compared with conventional completion angiography.
METHODS
We performed a systematic review that conformed to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. We considered studies reporting on the effectiveness of intra-operative CT during EVAR.
RESULTS
Our literature search yielded six studies that met our criteria for inclusion. In general, these showed intra-operative CT to be superior to completion angiogram at detecting intra-operative complications during EVAR. Despite concerns regarding irradiation, the use of intra-operative CT was found to expose patients to an overall lower radiation dose, since post-operative CT angiograms were no longer required. Moreover, no adverse effect on renal function has been demonstrated as a result of the increased intra-operative contrast usage when CT is used.
CONCLUSIONS
The current body of evidence suggests that intra-operative CT is superior to completion angiography at detecting clinically important EVAR complications and incurs a lower total radiation dose with no added risk of contrast-induced renal impairment. Further research directly comparing the two modalities in the same cohort is required to determine sensitivity for individual complications.
Topics: Aortic Aneurysm, Abdominal; Aortography; Blood Vessel Prosthesis Implantation; Endoleak; Endovascular Procedures; Humans; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31904305
DOI: 10.1024/0301-1526/a000840 -
The Thoracic and Cardiovascular Surgeon Oct 2020Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) may affect survival but data are conflicting. It is assessed by relating effective orifice area...
BACKGROUND
Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) may affect survival but data are conflicting. It is assessed by relating effective orifice area (EOA) to body surface area (EOAi). EOA is patient-specific as the result of flow-velocity times area at the individual patient's outflow tract levels (LVOT) divided by trans-prosthetic flow velocity. However, some studies use projected EOAs (i.e., valve size associated EOAs from other patient populations) to assess how PPM affects outcome.
METHODS
We analyzed 76 studies addressing hemodynamic outcome and/or mortality after bioprosthetic AVR.
RESULTS
In 48 studies, projected or measured EOA for calculation of EOAi and PPM assessment was used (of which 25 demonstrated an effect on survival). We identified 28 additional studies providing measured EOA values and the corresponding Bernoulli's pressure gradients after AVR. Despite EOA being a patient-specific parameter, 77% of studies assessing a PPM impact on survival used projected EOAs. The 28 studies are providing measured EOA values and the corresponding Bernoulli's pressure gradients in patients after AVR showed a highly significant, linear relationship between EOA and Bernoulli's gradient. Considering this relationship, it is surprising that relating EOA to body surface area (BSA) (EOAi) is standard but relating pressure gradients to BSA is not.
CONCLUSION
We conclude that the majority of studies assessing PPM have used false assumptions because EOA is a patient-specific parameter and cannot be transferred to other patients. In addition, the use of EOAi to assess PPM may not be appropriate and could explain the inconsistent relation between PPM and survival in previous studies.
Topics: Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Body Surface Area; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Risk Factors; Treatment Outcome
PubMed: 30609446
DOI: 10.1055/s-0038-1676814 -
Journal of Vascular Surgery Nov 2019The objective was to characterize the growing body of literature regarding nonoperative management of blunt thoracic aortic injury (BTAI).
OBJECTIVE
The objective was to characterize the growing body of literature regarding nonoperative management of blunt thoracic aortic injury (BTAI).
METHODS
A systematic search of MedLine, Embase, and Cochrane Central was completed to identify original articles reporting injury characteristics and outcomes in patients with BTAI managed nonoperatively during their index hospitalization. Article title and abstract screening, full-text review, and data abstraction were performed in duplicate, with discrepancies resolved by a third reviewer. The quality of each study was evaluated using the Oxford Centre for Evidence-Based Levels of Evidence.
RESULTS
Of 2162 identified studies, 74 were included and reported on 8606 patients with BTAI who were managed nonoperatively between 1970 and 2016. Only one study was prospective. The median nonoperative sample size per study was 11 patients. The characterization of aortic injury grade differed across studies. Follow-up varied widely from 1 day to 118 months. Injury healing or improvement on follow-up imaging occurred in 34% (226 of 673 patients; reported in 37 studies), most often in the context of grade I intimal injury. Injury progression or requirement for a thoracic endovascular aneurysm repair for injury progression was 7.6% (66 of 873 patients; reported in 46 studies). A total of 37 studies reported aortic-related death, with an overall rate of 4.5% (37 of 827 patients) and a rate of 1% in grade I and II injuries (1 of 153 patients) and 18% in grade III and IV (9 of 50 patients).
CONCLUSIONS
An increasing number of reports support nonoperative management of grade I intimal injury, consistent with Society for Vascular Surgery guidelines. However, a retrospective interpretation of the determinants of management, heterogeneous injury characterization, and variable follow-up remain major limitations to the informed use of nonoperative management across all BTAI grades.
Topics: Aorta, Thoracic; Clinical Decision-Making; Conservative Treatment; Disease Progression; Endovascular Procedures; Humans; Injury Severity Score; Practice Guidelines as Topic; Societies, Medical; Specialties, Surgical; Treatment Outcome; Vascular System Injuries; Wounds, Nonpenetrating
PubMed: 31126762
DOI: 10.1016/j.jvs.2019.02.023