Heart : official journal of the British Cardiac Society
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Review Meta Analysis
Do antioxidant vitamins have an anti-arrhythmic effect following cardiac surgery? A meta-analysis of randomised controlled trials.
Postoperative atrial fibrillation (POAF) affects approximately 30% of patients undergoing elective cardiac surgery. While its pathogenesis is multifactorial, increasing evidence supports a role for oxidative stress in the electrophysiological remodelling associated with AF. Although prophylactic antioxidants appear to be a potentially attractive pharmacotherapy, there is still uncertainty regarding their efficacy. This study aims to provide a quantitative summary of the current evidence surrounding antioxidant vitamins and POAF prevention. ⋯ The prophylactic use of vitamins C and E may significantly reduce the incidence of POAF and all-cause arrhythmia following cardiac surgery. However, the overall quality of current studies is poor and further research should focus on adequately powered randomised controlled trials that standardise AF reporting, antioxidant protocol and the use of concomitant agents. Cost analysis should be considered to establish the potential economic benefit of antioxidant vitamin prophylaxis in POAF.
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Review Meta Analysis
Surgical management of aortic root disease in Marfan syndrome: a systematic review and meta-analysis.
Surgical treatment of aortic root aneurysm in Marfan syndrome (MFS) patients. ⋯ VSRR may represent a valuable option for patients with MFS with aortic aneurysm. However, this technique should be used with caution in patients with valve characteristics at risk for decreased durability.
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Review Meta Analysis
Meta-analysis of randomised trials comparing the effectiveness of miniaturised versus conventional cardiopulmonary bypass in adult cardiac surgery.
The aim of this meta-analysis is to summarise the results of prospective, randomised studies comparing miniaturised (Mini-CPB) versus conventional cardiopulmonary bypass (C-CPB). ⋯ This meta-analysis suggests that the use of Mini-CPB may be associated with lower risk of postoperative stroke and blood losses and with a somewhat decreased mortality. However, due to the large heterogeneity of methods and the small number of studies and patients evaluated so far, larger and homogeneous studies should be performed to obtain more conclusive results on the safety and efficacy of Mini-CPB.
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Review Meta Analysis Comparative Study
Cost-effectiveness of radiofrequency catheter ablation for the treatment of atrial fibrillation in the United Kingdom.
To assess the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared with anti-arrhythmic drug (AAD) therapy for the treatment of atrial fibrillation (AF) from the perspective of the UK NHS. ⋯ RFCA is potentially cost-effective for the treatment of paroxysmal AF in patients' predominantly refractory to AAD therapy provided the quality-of-life benefits from treatment are maintained for more than 5 years. These findings remain subject to limitations in the existing evidence regarding the nature of life benefits and the prognostic importance of restoring normal sinus rhythm conferred using RFCA.
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Review Meta Analysis
Routine use of oxygen in the treatment of myocardial infarction: systematic review.
International guidelines recommend the routine use of oxygen therapy in the treatment of myocardial infarction (MI). ⋯ The limited evidence that does exist suggests that the routine use of high-flow oxygen in uncomplicated MI may result in a greater infarct size and possibly increase the risk of mortality.