The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2019
Meta AnalysisBioprosthetic aortic valve replacement in elderly patients: Meta-analysis and microsimulation.
To support decision-making in aortic valve replacement (AVR) in elderly patients, we provide a comprehensive overview of outcome after AVR with bioprostheses. ⋯ The low risks of SVD and reintervention support the use of bioprostheses in elderly patients in need of AVR. The estimated life expectancy after AVR was comparable with the general population. The results of this study inform patients and clinicians about the expected outcomes after bioprosthetic AVR and thereby support treatment decision-making. Furthermore, our results can be used as a benchmark for long-term outcomes after transcatheter aortic valve implantation in patients who were eligible for surgery and other (future) alternative treatments (eg, tissue-engineered heart valves).
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J. Thorac. Cardiovasc. Surg. · Jun 2019
Meta AnalysisAre racial differences in hospital mortality after coronary artery bypass graft surgery real? A risk-adjusted meta-analysis.
Despite several reports, there are still conflicting data on the influence of ethnicity on mortality rates associated with coronary artery bypass grafting (CABG). We aimed to get further insights into the effect of race on mortality following CABG by performing a risk adjusted meta-analysis. ⋯ The present meta-analysis showed that despite progress is being made in lowering in-hospital mortality rates among the major racial/ethnic groups, ethnical disparities in hospital mortality after CABG remain.
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J. Thorac. Cardiovasc. Surg. · May 2019
Meta AnalysisRadial artery versus saphenous vein as the second conduit for coronary artery bypass surgery: A meta-analysis.
Individual studies may be limited by sample size to detect differences in late survival between radial artery (RA) or saphenous vein graft (SVG) as a second conduit for coronary artery bypass surgery. Here we undertook a meta-analysis of the best evidence available on the comparison of early and late clinical outcomes of the RA and the SVG. ⋯ Compared with the SVG, using the RA as the second conduit is associated with a 26% relative risk reduction in mortality at 6.6-year follow-up.
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J. Thorac. Cardiovasc. Surg. · Jan 2019
Meta Analysis Comparative StudyA systematic review and meta-analysis of stereotactic body radiation therapy versus surgery for patients with non-small cell lung cancer.
Stereotactic body radiation therapy is the preferred treatment modality for patients with inoperable early-stage non-small cell lung cancer. However, comparative outcomes between stereotactic body radiation therapy and surgery for high-risk patients remain controversial. The primary aim of the present meta-analysis was to assess overall survival in matched and unmatched patient cohorts undergoing stereotactic body radiation therapy or surgery. Secondary end points included cancer-specific survival, disease-free survival, disease recurrence, and perioperative outcomes. ⋯ The current evidence suggests surgery is superior to stereotactic body radiation therapy in terms of mid- and long-term clinical outcomes; stereotactic body radiation therapy is associated with lower perioperative mortality. However, the improved outcomes after surgery may be due at least in part to an imbalance of baseline characteristics. Future studies should aim to provide histopathologic confirmation of malignancy and compare stereotactic body radiation therapy with minimally invasive anatomical resections.
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J. Thorac. Cardiovasc. Surg. · Oct 2018
Meta Analysis Comparative StudyAdjunct retrograde cerebral perfusion provides superior outcomes compared with hypothermic circulatory arrest alone: A meta-analysis.
Retrograde cerebral perfusion is becoming less frequently used as a method of neuroprotection during aortic surgery. The present meta-analysis aims to compare outcomes after arch surgery with hypothermic circulatory arrest versus hypothermic circulatory arrest + retrograde cerebral perfusion. ⋯ These results suggest that the addition of retrograde cerebral perfusion during aortic arch surgery may provide better outcomes than using hypothermic circulatory arrest alone, although significant confounders exist. Further robust studies are required to confirm the utility of retrograde cerebral perfusion in arch surgery.