Transcatheter versus surgical closure of atrial septal defects: a systematic review and meta-analysis of clinical outcomes

2021 ◽  
pp. 1-9
Author(s):  
Aimee-Louise Chambault ◽  
Kathryn Olsen ◽  
Louise J. Brown ◽  
Sophie L. Mellor ◽  
Nilofer Sorathia ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Hospital Stay ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Mean Difference ◽  
Complication Rates ◽  
Surgical Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Significant Difference

Abstract Background: Atrial septal defects are a common form of CHD and dependent on the size and nature of atrial septal defects, closure may be warranted. The paper aims to compare outcomes of transcatheter versus surgical repair of atrial septal defects. Methods: A comprehensive electronic literature search was conducted. Primary studies were included if they compared both closure techniques. Primary outcomes included procedural success, mortality, and reintervention rate. Secondary outcomes included residual defect and mean hospital stay. Results: A total of 33 studies were included in meta-analysis. Mean total hospital stay was significantly shorter in the transcatheter cohort across both the adult (95% confidence interval, mean difference −4.05 (−4.78, −3.32) p < 0.00001) and paediatric populations (95% confidence interval, mean difference −4.78 (−5.97, −3.60) p < 0.00001). There were significantly fewer complications in the transcatheter group across both the adult (odds ratio 0.45, 95% confidence interval, [0.28, 0.72], p < 0.00001) and paediatric cohorts (odds ratio 0.26, 95% confidence interval, [0.14, 0.49], p < 0.00001). No significant difference in overall mortality was found between transcatheter versus surgical closure across the two groups, adult (odds ratio 0.76, 95% confidence interval, [0.40, 1.45], p = 0.41), paediatrics (odds ratio 0.62, 95% confidence interval, [0.21, 1.83], p = 0.39). Conclusion: Both transcatheter and surgical approaches are safe and effective techniques for atrial septal defect closure. Our study has demonstrated the benefits of transcatheter closure in terms of lower complication rates and mean hospital stay. However, surgery still has a place for more complex closure and, as we have demonstrated, shows no difference in mortality.

Percutaneous versus surgical closure of secundum atrial septal defects: a systematic review and meta-analysis of currently available clinical evidence

2011 ◽  
Vol 7 (3) ◽  
pp. 377-385 ◽  
Author(s):  
Gianfranco Butera ◽  
Giuseppe Biondi-Zoccai ◽  
Giuseppe Sangiorgi ◽  
Raul Abella ◽  
Alessandro Giamberti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Evidence ◽  
Meta Analysis ◽  
Surgical Closure ◽  
Septal Defects ◽  
Atrial Septal Defects

scholarly journals Timing of cholecystectomy after percutaneous cholecystectomy for acute cholecystitis- A systematic review and meta-analysis

2021 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel
Keyword(s):  
Systematic Review ◽  
Hospital Stay ◽  
Biliary Tract ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Mean Difference ◽  
Complication Rates ◽  
Percutaneous Cholecystostomy ◽  
Timing Of Cholecystectomy

Introduction: There is a controversy about the optimum timing of cholecystectomy after percutaneous cholecystostomy. This systematic review and meta-analysis aimed to evaluate outcomes of early versus late cholecystectomy after percutaneous cholecystectomy. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used. We evaluated cholecystectomy performed at different periods after percutaneous cholecystostomy within 72 hours or later, within or after one week or percutaneous cholecystostomy, within 10 days or after 10 days, less than 2 weeks or more than 2 weeks, less than 4 weeks or more than 4 weeks, less than 8 weeks or more than 8 weeks as per literature. Results: Six studies including 18640 patients were included in the final analysis. There was no difference in overall complications within or after 72 hours cholecystectomy group, but mortality and biliary complications were significantly high in the less than 72 hours group (p=0.05 and 0.0002 respectively). There was no difference in mortality, overall complication, biliary tract complications in less than 1 week versus more than 1 week and less than 10 days versus more than 10 days group. Overall complications were significantly less in the less than 2 weeks group compared to the more than 2 weeks group. There was no difference in mortality and biliary tract complications between less than 2 weeks and more than 2 weeks group. Overall complication rate (risk ratio 0.67, p <0.0001), postoperative mortality (risk ratio 0.46, p=0.003), bile duct injury (risk ratio 0.62, p=0.01) was significantly less in earlier than 4-week group. Hospital stay was not significantly different between less than 4 weeks versus more than 4 weeks group. (Mean difference= -2.74, p=0.12). Ove all complication rates were significantly more in less than 8 weeks group. (Risk ratio 1.07, p=0.01). Hospital stay was significantly less in less than 8 weeks group. (Mean difference 0.87, p=0.01). Conclusion: Early cholecystectomy preferably within 4 weeks after percutaneous cholecystostomy is preferable over late cholecystectomy.

Systematic review and meta-analysis of the negative outcomes of retinopathy of prematurity treated with laser photocoagulation

2018 ◽  
Vol 29 (2) ◽  
pp. 223-228 ◽  
Author(s):  
Jing Liang
Keyword(s):  
Confidence Interval ◽  
Laser Treatment ◽  
Retinopathy Of Prematurity ◽  
Odds Ratio ◽  
Laser Photocoagulation ◽  
Meta Analysis ◽  
Anterior Chamber Depth ◽  
Mean Difference ◽  
Laser Coagulation ◽  
Spherical Equivalent

Introduction: Retinopathy of prematurity is a leading cause of potentially avertable childhood blindness around the world. And laser photocoagulation is currently performed as a gold standard for retinopathy of prematurity treatment, but it may contribute to elevated myopia and decreased visual field. Therefore, the objective of this meta-analysis is to explore the negative impact of laser photocoagulation for retinopathy of prematurity in terms of anatomic outcomes and structural outcomes. Methods: Studies were retrieved through literature searches in PubMed and EMBASE from 1990 to 2017 in English. Case-control studies that reported anatomic and structural changes or significant complications after laser coagulation or cryotherapy for retinopathy of prematurity were eligible. Results: This meta-analysis included eight original studies related to laser treatment for retinopathy of prematurity at any stages. A total of 1422 infants were participated, of which 1156 documented subthreshold or threshold retinopathy of prematurity without laser treatment were selected as comparison group and the rest treated with diode or argon laser coagulation were chosen for experiment group. Taking all included studies into account, spherical equivalent (mean difference −2.53, 95% confidence interval: –5.23 to 0.18, I2 = 96%, P < 0.00001), anterior chamber depth (mean difference −0.52, 95% confidence interval: −0.76 to −0.28, I2 = 55%, P = 0.11), astigmatism (odds ratio 3.19, 95% confidence interval: 1.61 to 6.32, I2 = 0%, P = 0.54), and myopia (odds ratio 8.08, 95% confidence interval: 3.79 to 17.23, I2 = 37%, P = 0.21) were associated with laser treatment for retinopathy of prematurity. Axial length (mean difference −0.01, 95% confidence interval: –0.28 to 0.27, I2 = 0%, P = 0.62) and anisometropia (odds ratio 4.21, 95% confidence interval: 0.54 to 33.17, I2 = 1%, P = 0.31) had no statistical significance on laser coagulation for retinopathy of prematurity. Conclusion: This meta-analysis showed that spherical equivalent, anterior chamber depth, astigmatism, and myopia were associated with the negative outcomes of laser coagulation, while axial length and anisometropia had no statistical importance on the defects of laser coagulation. Therefore, patients treated with laser coagulation should follow periodic cycloplegic refraction and receive early optical correction.

Transthoracic three-dimensional echocardiography prior to closure of atrial septal defects in children

2003 ◽  
Vol 13 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Philippe Acar ◽  
Daniel Roux ◽  
Yves Dulac ◽  
Pierre Rougé ◽  
Yacine Aggoun
Keyword(s):  
Three Dimensional ◽  
Mean Difference ◽  
Complete Agreement ◽  
Surgical Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Maximal Diameter ◽  
The Mean ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography

Aims:Our aims were to use transthoracic three-dimensional echocardiography to assess the morphology of atrial septal defects in children prior to closure, and to compare the three-dimensional echocardiographic data with transcatheter and surgical findings.Methods and results:We used transthoracic three-dimensional echocardiography in 62 consecutive patients, aged from 2 to 18 years, with atrial septal defects, measuring the maximal diameter and the extent of the rims. Subsequent to the study, we referred 42 patients for transcatheter closure, the rims being measured at greater than 4 mm. We found a good correlation between the maximal diameter of the defect as measured at transthoracic three-dimensional echocardiography and using a balloon (y = 3.45 − 0.73x; r = 0.78; p < 0.0001), the mean difference between the measurements being 2.4 ± 2.8 mm. Successful closure with the Amplatzer septal occluder, having a mean size of 22 ± 4 mm, was achieved in 95% of the patients. Of the original cohort, 20 patients were referred for surgical closure. In these patients, the inferior rim had been deemed insufficient in 5, the postero-superior rim in 6, and the postero-inferior rim in 9. Complete agreement was found when the deficiency of the rim as judged using transthoracic three-dimensional echocardiography was compared with intraoperative findings. The correlation between measurements of the deficiency of the rim achieved by transthoracic three-dimensional echocardiography and at surgery was excellent (y = 0.2 + 0.98x; r = 0.93; p < 0.0001), the mean difference between the measurements being no more than 0.6 ± 0.4 mm.Conclusions:Transthoracic three-dimensional echocardiography proved accurate in measuring the maximal diameter and rims of atrial septal defects within the oval fossa. This non-invasive method will be valuable in selecting children for transcatheter or surgical closure of such defects.

scholarly journals Efficacy of Transparent vs. Pressure Dressing in Prevention of Post-Cardiac Catheterization Pain, Discomfort and Hematoma: A Systematic Review and Meta-analysis of RCTs

2021 ◽  
Vol 10 (2) ◽  
pp. 103-110
Author(s):  
Suresh K Sharma ◽  
Kalpana Thakur ◽  
Shiv K Mudgal ◽  
Barun Kumar
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Cardiac Catheterization ◽  
Odds Ratio ◽  
English Language ◽  
Data Extraction ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Significant Difference ◽  
Pressure Dressing

ABSTRACT Introduction: There is lack consensus on superiority of transparent vs. pressure dressing for prevention of post-cardiac catheterization pain, discomfort and hematoma. Therefore, we conducted this systematic review and meta-analysis of available RCTs on this subject. Methods: We performed a systematic search of RCTs published between in 2000-2019 in English language using databases including PubMed Medline, EMBASE, CINAHL, Cochrane Library, ERMED Journals, Clinical trials database, DELNET, Google Scholar and Discovery Search. Studies conducted on adult patients with femoral dressing after cardiac catheterization measuring pain, discomfort, hematoma as intended outcomes have been included. Data extraction, critical appraisal, assessment of risk bias was done and decisions on quality were made on mutual consensus. Mantel-Haenszel (MH) and odds ratio for dichotomous variables was calculated by Review Manager 5.3 software. Results: Out of all identified studies, only 5 studies comprising 664 patients fulfilled the inclusion criteria and met the quality assessment. Incidence of discomfort (25, 333) were significantly less in transparent dressing group as compared to pressure dressing group (149, 331); odds ratio 0.10, 95% confidence interval [CI] 0.06-0.15; I2 = 0%, P= 0.00. Four studies reported significantly lower number of pain cases in transparent dressing (17, 203) as compared to pressure dressing (57, 201); odds ratio 0.13, 95% confidence interval [CI] 0.03-0.59; I2 = 47%, P= 0.01). However, incidence of hematoma did not reveal any significant difference between two groups. Conclusion: Transparent dressing is a better option in patients with femoral/groin dressing after cardiac catheterization as it is more effective in prevention of pain and discomfort.

scholarly journals Isolated Tricuspid Valve Surgery – Repair Versus Replacement: a Meta-analysis

2021 ◽  
Author(s):  
Panagiotis Sarris-Michopoulos ◽  
Alejandro Macias ◽  
Constantine Sarris-Michopoulos ◽  
Palina Woodhouse ◽  
Daniel Buitrago ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Publication Bias ◽  
Tricuspid Valve ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Tricuspid Valve Surgery ◽  
Significant Difference ◽  
Pacemaker Placement

Objective: There is paucity of data on outcomes after isolated tricuspid valve surgery. This meta-analysis aims to compile available data on isolated tricuspid valve surgery and compare isolated tricuspid valve repair (iTVr) with isolated tricuspid valve replacement (iTVR) to elucidate outcomes after tricuspid valve surgery. Methods: A literature search of 6 databases was performed. The primary outcomes was 30-day mortality. Secondary outcomes were early stroke, post-op pacemaker placement, and tricuspid reoperation within 5 years. Publication bias was explored using the funnel plot. Results: Ten retrospective studies involving 1407 patients (iTVr group = 779 patients and iTVR group = 628 patients) were included. A cumulative analysis demonstrated a significant difference favoring iTVr for 30-day mortality [odds ratio – 10 studies (95% confidence interval) 0.34 (0.18-0.66)]; 4.7% versus 12.6%, for iTVr and iTVR, respectively. Post-op pacemaker placement favored iTVr [odds ratio – 6 studies (95% confidence interval) 0.37 (0.18-0.77)]. Although stroke rates and TV reoperation favored iTVr, they did not reach statistical significance. No publication bias was identified. Conclusions: This meta-analysis demonstrates that iTVr has better 30-day mortality and fewer permanent pacemaker placements. Etiology and severity of TR, as well as careful patient selection remain the most important factors for optimal outcomes.

Tubeless versus standard percutaneous nephrolithotomy in pediatric patients: a systematic review and meta-analysis

2017 ◽  
Vol 85 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Akbar Nouralizadeh ◽  
Nasser Simforoosh ◽  
Hamidreza Shemshaki ◽  
Mohammad H. Soltani ◽  
Mehdi Sotoudeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Operation Time ◽  
Mean Difference ◽  
Transfusion Rate ◽  
Stone Clearance ◽  
Significant Difference ◽  
Tubeless Pcnl

Background: This systematic review and meta-analysis was designed to evaluate the post-operative outcomes between tubeless and standard percutaneous nephrolithotomy (PCNL) among children. Methods: Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included three trials investigating the outcomes including the length of hospital stay, operation time, hemoglobin decrease, blood transfusion rate, perirenal fluid presence, post-operative fever, stone clearance rate, and the need for a second operation. Results: The patients who underwent tubeless PCNL had shorter length of hospitalization compared to standard PCNLs (mean difference -1.57, 95% confidence interval -3.2 to 0.07, p = 0.06). No significant decrease was detected in hemoglobin after tubeless PCNL compared to standard PCNL (mean difference 0.05, 95% confidence interval -0.03 to 0.13, p = 0.21). There were no significant differences in operation time (p = 0.7), perirenal fluid presence (p = 0.15), post-operative fever (p = 0.72), stone clearance (p = 0.68), and the need for a second operation (p = 0.90). Conclusions: This study showed no significant difference between tubeless and standard PCNLs in children. However, due to the lack of data, the results should be mentioned prudently. Future randomized trials with more sample sizes and longer follow-ups are warranted.

On-clamp versus off-clamp robotic partial nephrectomy: A systematic review and meta-analysis

2019 ◽  
Vol 86 (2) ◽  
pp. 52-62 ◽  
Author(s):  
Alessandro Antonelli ◽  
Alessandro Veccia ◽  
Simone Francavilla ◽  
Riccardo Bertolo ◽  
Pierluigi Bove ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Partial Nephrectomy ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Robotic Partial Nephrectomy ◽  
Weighted Mean ◽  
Robot Assisted ◽  
Significant Difference

Background: The debate on the pros and cons of robot-assisted partial nephrectomy performed with (on-clamp) or without (off-clamp) renal artery clamping is ongoing. The aim of this meta-analysis is to summarize the available evidence on the comparative studies assessing the outcomes of these two approaches. Material and methods: A systematic review of the literature on PubMed, ScienceDirect®, and Embase® was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA). Only comparative and case-control studies were submitted to full-text assessment and meta-analysis. RevMan 5.3 software was used. Results: From the initial retrieval of 1937 studies, 15 fulfilling inclusion criteria were selected and provided 2075 patients for analysis (702 off-clamp, 1373 on-clamp). Baseline tumor’s features showed a significant difference in size (weighted mean difference: –0.58 cm; 95% confidence interval: [–1.06, –0.10]; p = 0.02) and R.E.N.A.L. score (weighted mean difference: –0.53; 95% confidence interval: [–0.81, –0.25]; p = 0.0002), but not in the exophytic property, the location, and the PADUA score. Pooled analysis revealed shorter operative time (p = 0.02) and higher estimated blood loss (p = 0.0002) for the off-clamp group. Overall complication and transfusion rates were similar, while higher major complication rate was observed in the on-clamp approach (5.6% vs 1.9%, p = 0.03). No differences in oncological outcomes were found. Finally, functional outcomes (assessed by estimated glomerular filtration rate at early postoperative, 3 month, 6 month, and last available follow-up) were not statistically different. Conclusion: This meta-analysis shows that off-clamp robot-assisted partial nephrectomy is reserved to smaller renal masses. Under such conditions, no differences with the on-clamp approach emerged.

scholarly journals The effectiveness of nonsteroidal anti-inflammatory drugs and acetaminophen in reduce the risk of amyotrophic lateral sclerosis? A meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Min Cheol Chang ◽  
Sang Gyu Kwak ◽  
Jin-Sung Park ◽  
Donghwi Park
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Convincing Evidence ◽  
Cochrane Library ◽  
Control Group ◽  
Inclusion Criteria ◽  
Control Groups ◽  
Significant Difference ◽  
And Control

Abstract To test the hypothesis that aspirin, non-aspirin nonsteroidal anti-infammatory drugs (NA-NSAIDs), or acetaminophen can reduce the risk of ALS, we conducted a systematic review and meta-analysis of related previous studies. A comprehensive search was conducted on the PubMed, Embase, Cochrane Library and SCOPUS databases. It included studies published up to 29 February 2020 that fulfilled our inclusion criteria. Aspirin, acetaminophen and NA-NSAIDs use information, between the ALS and control groups, was collected for the meta-analysis. Rates of aspirin, NA-NSAID, and acetaminophen use in ALS group, compared with control group were investigated. In the results, only three studies that relate the risk of ALS to aspirin, NA-NSAIDs and acetaminophen use satisfied the inclusion criteria for the meta-analysis. Regarding aspirin, the studies did not show any statistically significant difference in aspirin use between the ALS and control groups (Odds ratio, 1.04 [95% confidence interval, 0.90–1.21]). NA-NSAIDs and acetaminophen use, however, did show up statistically significant differences in between the ALS and control groups. (Odds ratio, 0.82 [95% confidence interval, 0.73–0.91]) and (Odds ratio, 0.80 [95% confidence interval, 0.69–0.93]). However, our study has some limitations. Firstly, we only included a small number of studies. Secondly, the included studies did not control for past medical history, which may have confounded their results, and in turn, could have caused bias in our study. Thirdly, in this meta-analysis, the ALS patients were not subdivided into sporadic or familial type. Lastly, the studies also did not consider the types of NSAIDs and dosages used of each drug. For more convincing evidence regarding the effectiveness of aspirin, NA-NSAIDs and acetaminophen to reduce the risk of ALS occurrence, more qualified prospective studies are required. In conclusion, the use of NA-NSAIDs and acetaminophen is associated with a decreased risk for the development of ALS. In contrast, aspirin did not have any effect on the reduction of the risk of ALS occurrence.

Association between CD40 polymorphisms and systemic lupus erythematosus and correlation between soluble CD40 and CD40 ligand levels in the disease: a meta-analysis

Lupus ◽  
2019 ◽  
Vol 28 (12) ◽  
pp. 1452-1459 ◽  
Author(s):  
S -C Bae ◽  
Y H Lee
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Confidence Interval ◽  
Lupus Erythematosus ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Cd40 Ligand ◽  
Mean Difference ◽  
Systemic Lupus ◽  
Systemic Lupus Erythematosus Group ◽  
Standardized Mean Difference

Objective The aim of this study was to systematically review evidence regarding the association between CD40 polymorphisms and systemic lupus erythematosus and between soluble CD40 (sCD40) and CD40 ligand (sCD40L) levels and systemic lupus erythematosus. Methods We performed a meta-analysis on the association between CD40 rs4810495, rs1883832, and rs376545 polymorphisms and systemic lupus erythematosus risk and sCD40/sCD40L levels in patients with systemic lupus erythematosus and controls. Results Fourteen studies were included. Ethnicity-specific meta-analysis indicated a significant association between the T allele of CD40 rs4810485 polymorphism and systemic lupus erythematosus in Europeans (odds ratio = 0.715, 95% confidence interval = 0.641–0.832, p < 0.001) and a trend toward an association between the T allele and systemic lupus erythematosus in Asians (odds ratio = 1.255, 95% confidence interval = 0.978–1.810, p = 0.074). Furthermore, a significant association was reported between systemic lupus erythematosus and the C allele of CD40 rs1883832 polymorphism (odds ratio = 1.235, 95% confidence interval = 1.087–1.405, p = 0.001) and A allele of CD40 rs3765456 polymorphism and systemic lupus erythematosus in Asians (odds ratio = 1.184, 95% confidence interval = 1.040–1.348, p = 0.011). sCD40 and sCD40L levels were significantly higher in SLE than in controls (standardized mean difference = 1.564, 95% confidence interval = 0.256–2.872, p = 0.019 and standardized mean difference = 1.499, 95% confidence interval = 1.031–1.967, p < 0.001, respectively). Stratification based on ethnicity revealed higher sCD40L levels in the systemic lupus erythematosus group among European, Asian, North American, and Arab populations. Conclusions Our meta-analyses found associations between CD40 rs4810495, rs1883832, and rs376545 polymorphisms and systemic lupus erythematosus susceptibility and significantly higher sCD40 and sCD40L levels in patients with systemic lupus erythematosus than in controls.

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