scholarly journals Right internal thoracic artery versus radial artery as the second best arterial conduit: Insights from a meta-analysis of propensity-matched data on long-term survival

2016 ◽  
Vol 152 (4) ◽  
pp. 1083-1091.e15 ◽  
Author(s):  
Umberto Benedetto ◽  
Mario Gaudino ◽  
Massimo Caputo ◽  
Robert F. Tranbaugh ◽  
Christopher Lau ◽  
...  
Keyword(s):  
Radial Artery ◽  
Internal Thoracic Artery ◽  
Meta Analysis ◽  
Term Survival ◽  
Long Term Survival ◽  
Second Best ◽  
Right Internal Thoracic Artery ◽  
Arterial Conduit ◽  
Matched Data

scholarly journals Right internal thoracic artery or radial artery? A propensity-matched comparison on the second-best arterial conduit

2017 ◽  
Vol 153 (1) ◽  
pp. 79-88.e4 ◽  
Author(s):  
Umberto Benedetto ◽  
Massimo Caputo ◽  
Mario Gaudino ◽  
Roberto Marsico ◽  
Cha Rajakaruna ◽  
...  
Keyword(s):  
Radial Artery ◽  
Internal Thoracic Artery ◽  
Second Best ◽  
Right Internal Thoracic Artery ◽  
Arterial Conduit ◽  
Matched Comparison

scholarly journals SHORT- AND LONG-TERM OUTCOMES OF A SECOND ARTERIAL CONDUIT FOLLOWING CORONARY BYPASS GRAFTING

2021 ◽  
Author(s):  
Sleiman Sebastian Aboul-Hassan ◽  
Jakub Marczak ◽  
Tomasz Stankowski ◽  
Lukasz Moskal ◽  
Maciej Peksa ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Deep Sternal Wound Infection ◽  
Bypass Grafting ◽  
Short Term ◽  
Term Survival ◽  
Long Term Outcome ◽  
Long Term Survival ◽  
Arterial Conduit ◽  
Long Term Mortality

Background: The aim of this study was to assess the effect on short-term outcomes and long-term survival in patients following coronary artery bypass grafting in whom second arterial conduit(right internal thoracic artery-RITA or radial artery-RA) or saphenous vein was grafted and between RITA and RA as second best arterial conduit. Methods: Between January-2006 and June-2018, 7857-patients met the inclusion criteria and were divided into two groups: single internal thoracic artery: SITA+Vein group(n=7140) and 2nd-arterial conduit group(n=717), of these 537-patients received RITA and 180-patients received RA. Short‐term outcomes included: 30-day mortality and Major Adverse Cardiac and Cerebral Events(MACCE), reoperation for bleeding and deep sternal wound infection(DSWI). The long‐term outcome was all‐cause mortality. propensity score(PS) matching was used to match patients between the groups. Results: Before as well as after PS-matching, no significant differences were observed between 2nd-arterial conduit vs SITA+Vein groups and between RITA vs RA groups in terms of 30-day mortality, 30-day MACCE, reoperation for bleeding and incidence of DSWI. The use of 2nd-arterial conduit was associated with a significant reduction in long-term mortality before(HR:0.52;95%CI;0.43-0.64;p<0.001) as well as after PS-matching(HR:0.77;95%CI;0.60-0.99;p=0.04). RA and RITA as second arterial conduit had comparable long-term mortality before(HR:1.22;95%CI;0.82-1.82;p=0.3) as well as after PS-matching(HR:0.96;95%CI;0.58-1.58;p=0.87). Conclusions: The use of 2nd-arterial conduit vs vein is associated with improved long-term survival. As for the 2nd-best arterial conduit, RA and RITA had comparable long-term mortality.

scholarly journals Bilateral internal thoracic artery versus single internal thoracic artery: a meta-analysis of propensity score-matched observational studies

2019 ◽  
Vol 29 (2) ◽  
pp. 163-172 ◽  
Author(s):  
Stefano Urso ◽  
Eliú Nogales ◽  
Jesús María González ◽  
Rafael Sadaba ◽  
María Ángeles Tena ◽  
...  
Keyword(s):  
Propensity Score ◽  
Wound Infection ◽  
Risk Ratio ◽  
Internal Thoracic Artery ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Deep Sternal Wound Infection ◽  
Term Survival ◽  
Long Term Survival

Abstract The lack of benefit in terms of mid-term survival and the increase in the risk of sternal wound complications published in a recent randomized controlled trial have raised concerns about the use of bilateral internal thoracic artery (BITA) in myocardial revascularization surgery. For this reason, we decided to explore the current evidence available on the subject by carrying out a meta-analysis of propensity score-matched studies comparing BITA versus single internal thoracic artery (SITA). PubMed, EMBASE and Google Scholar were searched for propensity score-matched studies comparing BITA versus SITA. The generic inverse variance method was used to compute the combined hazard ratio (HR) of long-term mortality. The DerSimonian and Laird method was used to compute the combined risk ratio of 30-day mortality, deep sternal wound infection and reoperation for bleeding. Forty-five BITA versus SITA matched populations were included. Meta-analysis showed a significant benefit in terms of long-term survival in favour of the BITA group [HR 0.78; 95% confidence interval (CI) 0.71–0.86]. These results were consistent with those obtained by a pooled analysis of the matched populations comprising patients with diabetes (HR 0.65; 95% CI 0.43–0.99). When compared with the use of SITA plus radial artery, BITA did not show any significant benefit in terms of long-term survival (HR 0.86; 95% CI 0.69–1.07). No differences between BITA and SITA groups were detected in terms of 30-day mortality or in terms of reoperation for bleeding. Compared with the SITA group, patients in the BITA group had a significantly higher risk of deep sternal wound infection (risk ratio 1.66; 95% CI 1.41–1.95) even when the pooled analysis was limited to matched populations in which BITA was harvested according to the skeletonization technique (risk ratio 1.37; 95% CI 1.04–1.79). The use of BITA provided a long-term survival benefit compared with the use of SITA at the expense of a higher risk of sternal deep wound infection. The long-term survival advantage of BITA is undetectable when compared with SITA plus radial artery.

scholarly journals The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

2021 ◽  
Vol 28 ◽  
pp. 107327482199743
Author(s):  
Ke Chen ◽  
Xiao Wang ◽  
Liu Yang ◽  
Zheling Chen
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Meta Analysis ◽  
Response Rates ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival ◽  
And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

scholarly journals The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement —Meta-Analysis

2020 ◽  
Vol 17 (19) ◽  
pp. 7335
Author(s):  
Ilija Bilbija ◽  
Milos Matkovic ◽  
Marko Cubrilo ◽  
Nemanja Aleksic ◽  
Jelena Milin Lazovic ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Meta Analysis ◽  
Reverse Remodeling ◽  
Term Survival ◽  
Long Term Survival

Aortic valve replacement for aortic stenosis represents one of the most frequent surgical procedures on heart valves. These patients often have concomitant mitral regurgitation. To reveal whether the moderate mitral regurgitation will improve after aortic valve replacement alone, we performed a systematic review and meta-analysis. We identified 27 studies with 4452 patients that underwent aortic valve replacement for aortic stenosis and had co-existent mitral regurgitation. Primary end point was the impact of aortic valve replacement on the concomitant mitral regurgitation. Secondary end points were the analysis of the left ventricle reverse remodeling and long-term survival. Our results showed that there was significant improvement in mitral regurgitation postoperatively (RR, 1.65; 95% CI 1.36–2.00; p < 0.00001) with the average decrease of 0.46 (WMD; 95% CI 0.35–0.57; p < 0.00001). The effect is more pronounced in the elderly population. Perioperative mortality was higher (p < 0.0001) and long-term survival significantly worse (p < 0.00001) in patients that had moderate/severe mitral regurgitation preoperatively. We conclude that after aortic valve replacement alone there are fair chances but for only slight improvement in concomitant mitral regurgitation. The secondary moderate mitral regurgitation should be addressed at the time of aortic valve replacement. A more conservative approach should be followed for elderly and high-risk patients.

scholarly journals Long-term survival after use of internal thoracic artery in octogenarians is gender related

2015 ◽  
Vol 150 (4) ◽  
pp. 891-899 ◽  
Author(s):  
Arun K. Singh ◽  
Andrew D. Maslow ◽  
Jason T. Machan ◽  
James G. Fingleton ◽  
William C. Feng ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Term Survival ◽  
Long Term Survival

665 PROPHYLACTIC THORACIC DUCT OBSTRUCTION DURING ESOPHAGECTOMY: THE IMPACT ON PERIOPERATIVE RISKS AND LONG-TERM SURVIVAL. A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Clara Santos ◽  
Laura Santos ◽  
Leticia Datrino ◽  
Guilherme Tavares ◽  
Luca Tristão ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Thoracic Duct ◽  
Meta Analysis ◽  
Term Survival ◽  
Long Term Survival ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

Abstract   During esophagectomy for cancer, there is no consensus if prophylactic thoracic duct ligation (TDL), with or without thoracic duct resection (TDR), could influence the perioperative outcomes and long-term survival. This systematic review and meta-analysis compared patients who went through esophagectomy associated or not to ligation or resection of the thoracic duct. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central and Lilacs (BVS). The inclusion criteria were: (1) studies that compare thoracic duct ligation, with or without resection, and non-thoracic duct ligation; (2) involve adult patients with esophageal cancer; (3) articles that analyses the outcomes—perioperative complications, perioperative mortality, chylothorax development and overall survival; (4) only clinical trials and cohort were accepted. A 95% confidence interval (CI) was used, and random-effects model was performed. Results Fifteen articles were selected, comprising 6,249 patients. TDL did not reduce the risk for chylothorax (Risk difference [RD]: -0.01; 95%CI: −0.02, 0.00). Also, TDL did not influence the risk for complications (RD: -0.02; 95%CI: −0.11, 0.07); mortality (RD: 0.00; 95%CI: −0.00, 0.00); and reoperation rate (RD: -0.01; 95%CI: −0.02, 0.00). TDR was associated with higher risk for postoperative complications (RD: 0.1; 95%CI 0.00, 0.19); chylothorax (RD: 0.02; 95%CI 0.00, 0.03). Both TDL and TDR did not influence the overall survival rate (TDL: HR: 1.17; 95%CI: 0.86, 1.48; and TDR: HR: 1.16; 95%CI: 0.8, 1.51). Conclusion Thoracic duct obliteration with or without its resection during esophagectomy does not change long term survival. Nonetheless, TDR increased the risk for postoperative complications and chylothorax.

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