J.W. Taco Boltje , Mathijs T. Carvalho Mota , Michiel D. Vriesendorp , Alexander B.A. Vonk , Rolf H.H. Groenwold , Robert J.M. Klautz , Bart J.J. Velders
{"title":"在主动脉瓣置换手术中使用质粒加固缝合线：系统回顾和荟萃分析","authors":"J.W. Taco Boltje , Mathijs T. Carvalho Mota , Michiel D. Vriesendorp , Alexander B.A. Vonk , Rolf H.H. Groenwold , Robert J.M. Klautz , Bart J.J. Velders","doi":"10.1016/j.ijcha.2024.101494","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Literature presents conflicting results on the pros and cons of pledget-reinforced sutures during surgical aortic valve replacement (SAVR). We aimed to investigate the effect of pledget-reinforced sutures versus sutures without pledgets during SAVR on different outcomes in a systematic review and <em>meta</em>-analysis.</p></div><div><h3>Methods</h3><p>A literature search was performed in five different medical literature databases. Studies must include patients undergoing SAVR and must compare any pledget-reinforced with any suturing technique without pledgets. The primary outcome was paravalvular leakage (PVL), and secondary outcomes comprised thromboembolism, endocarditis, mortality, mean pressure gradient (MPG) and effective orifice area (EOA). Results were pooled using a random-effects model as risk ratios (RRs) or mean differences (MDs) for which the no pledgets group served as reference.</p></div><div><h3>Results</h3><p>Nine observational studies met the inclusion criteria. The risk of bias was critical in seven studies, and high and moderate in two other. The pooled RR for moderate or greater PVL was 0.59 (95 % confidence interval [CI] 0.13, 2.73). The pooled RR for mortality at 30-days was 1.02 (95 % CI 0.48, 2.18) and during follow-up was 1.15 (95 % CI 0.67, 2.00). For MPG and EOA at 1-year follow-up, the pooled MDs were 0.60 mmHg (95 % CI −4.92, 6.11) and −0.03 cm<sup>2</sup> <!-->(95 % CI −0.18, 0.12), respectively.</p></div><div><h3>Conclusions</h3><p>Literature on the use of pledget-reinforced sutures during SAVR is at high risk of bias. Pooled results are inconclusive regarding superiority of either pledget-reinforced sutures or sutures without pledgets. Hence, there is no evidence to support or oppose the use of pledget-reinforced sutures.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101494"},"PeriodicalIF":2.5000,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S235290672400160X/pdfft?md5=d1880f989e53e9cd9e341144ccad3ca5&pid=1-s2.0-S235290672400160X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"The use of pledget-reinforced sutures during surgical aortic valve replacement: A systematic review and meta-analysis\",\"authors\":\"J.W. Taco Boltje , Mathijs T. Carvalho Mota , Michiel D. Vriesendorp , Alexander B.A. Vonk , Rolf H.H. Groenwold , Robert J.M. Klautz , Bart J.J. Velders\",\"doi\":\"10.1016/j.ijcha.2024.101494\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Literature presents conflicting results on the pros and cons of pledget-reinforced sutures during surgical aortic valve replacement (SAVR). We aimed to investigate the effect of pledget-reinforced sutures versus sutures without pledgets during SAVR on different outcomes in a systematic review and <em>meta</em>-analysis.</p></div><div><h3>Methods</h3><p>A literature search was performed in five different medical literature databases. Studies must include patients undergoing SAVR and must compare any pledget-reinforced with any suturing technique without pledgets. The primary outcome was paravalvular leakage (PVL), and secondary outcomes comprised thromboembolism, endocarditis, mortality, mean pressure gradient (MPG) and effective orifice area (EOA). Results were pooled using a random-effects model as risk ratios (RRs) or mean differences (MDs) for which the no pledgets group served as reference.</p></div><div><h3>Results</h3><p>Nine observational studies met the inclusion criteria. The risk of bias was critical in seven studies, and high and moderate in two other. The pooled RR for moderate or greater PVL was 0.59 (95 % confidence interval [CI] 0.13, 2.73). The pooled RR for mortality at 30-days was 1.02 (95 % CI 0.48, 2.18) and during follow-up was 1.15 (95 % CI 0.67, 2.00). For MPG and EOA at 1-year follow-up, the pooled MDs were 0.60 mmHg (95 % CI −4.92, 6.11) and −0.03 cm<sup>2</sup> <!-->(95 % CI −0.18, 0.12), respectively.</p></div><div><h3>Conclusions</h3><p>Literature on the use of pledget-reinforced sutures during SAVR is at high risk of bias. Pooled results are inconclusive regarding superiority of either pledget-reinforced sutures or sutures without pledgets. 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The use of pledget-reinforced sutures during surgical aortic valve replacement: A systematic review and meta-analysis
Objective
Literature presents conflicting results on the pros and cons of pledget-reinforced sutures during surgical aortic valve replacement (SAVR). We aimed to investigate the effect of pledget-reinforced sutures versus sutures without pledgets during SAVR on different outcomes in a systematic review and meta-analysis.
Methods
A literature search was performed in five different medical literature databases. Studies must include patients undergoing SAVR and must compare any pledget-reinforced with any suturing technique without pledgets. The primary outcome was paravalvular leakage (PVL), and secondary outcomes comprised thromboembolism, endocarditis, mortality, mean pressure gradient (MPG) and effective orifice area (EOA). Results were pooled using a random-effects model as risk ratios (RRs) or mean differences (MDs) for which the no pledgets group served as reference.
Results
Nine observational studies met the inclusion criteria. The risk of bias was critical in seven studies, and high and moderate in two other. The pooled RR for moderate or greater PVL was 0.59 (95 % confidence interval [CI] 0.13, 2.73). The pooled RR for mortality at 30-days was 1.02 (95 % CI 0.48, 2.18) and during follow-up was 1.15 (95 % CI 0.67, 2.00). For MPG and EOA at 1-year follow-up, the pooled MDs were 0.60 mmHg (95 % CI −4.92, 6.11) and −0.03 cm2 (95 % CI −0.18, 0.12), respectively.
Conclusions
Literature on the use of pledget-reinforced sutures during SAVR is at high risk of bias. Pooled results are inconclusive regarding superiority of either pledget-reinforced sutures or sutures without pledgets. Hence, there is no evidence to support or oppose the use of pledget-reinforced sutures.
期刊介绍：
IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.
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