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ABSTRACT Introduction: Ventricular septal rupture is an important high-mortality complication in the scope of myocardial infarctions. The effectiveness of different treatment modalities is still controversial. This meta-analysis compares the efficacy of percutaneous closure vs. surgical repair for the treatment of postinfarction ventricular septal rupture (PI-VSR). Methods: A meta-analysis was performed on relevant studies found through PubMed®, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (or CNKI), Wanfang Data, and VIP databases searching. The primary outcome was a comparison of in-hospital mortality between the two treatments, and the secondary outcome was documentation of one-year mortality, postoperative residual shunts, and postoperative cardiac function. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships between predefined surgical variables and clinical outcomes. Results: Qualified studies (742 patients from 12 trials) were found and investigated for this meta-analysis (459 patients in the surgical repair group, 283 patients in the percutaneous closure group). When comparing surgical repair to percutaneous closure, it was found that the former significantly reduced in-hospital mortality (OR: 0.67, 95% CI 0.48-0.96, P=0.03) and postoperative residual shunts (OR: 0.03, 95% CI 0.01-0.10, P<0.00001). Surgical repair also improved postoperative cardiac function overall (OR: 3.89, 95% CI 1.10-13.74, P=0.04). However, there was no statistically significant difference in one-year mortality between the two surgical strategies (OR: 0.58, 95% CI 0.24-1.39, P=0.23). Conclusion: We found that surgical repair appears to be a more effective therapeutic option than percutaneous closure for PI-VSR.
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@#Objective To summarize the efficacy of different anticoagulation methods during perioperative period of non-cardiac surgery after cardiac valve replacement and to compare the postoperative bleeding-related complications and embolization-related complications. Methods Retrospective analysis of clinical data of 56 patients who underwent non-cardiac surgery after cardiac valve replacement in our hospital from January 2016 to January 2018 was conducted. There were 27 males and 29 females, aged 19-75 (53.56±13.94) years. According to different anticoagulation methods during perioperative period, the patients were divided into a bridging group (32 patients) and a non-bridging group (24 patients). The postoperative hospital stay, the number of patients needing postoperative blood transfusions, bleeding-related complications and embolization-related complications were compared between the two groups. According to the patient’s perioperative embolization risk, each group of patients were divided into a high-risk subgroup, middle-risk subgroup, and low-risk subgroup, and the bleeding-related complications and embolization-related complications in each subgroup were compared. Results The postoperative hospital stay in the bridging group was significantly longer than that in the non-bridging group (P<0.05), but there was no significant difference in the number of patients needing postoperative blood transfusions, overall bleeding-related complications and embolization-related complications between the two groups (P>0.05). Subgroup analysis was performed according to the degree of embolization risk in the perioperative period. The incidence of bleeding-related complications of the non-bridging group in the high-risk subgroup was significantly higher than that in the high-risk subgroup of the bridging group (P<0.05). The incidence of bleeding-related complications in the bridging group was similar to that of embolization-related complications, while the rate of bleeding-related complications in the non-bridging group was 7 times higher than that of embolization-related complications. Conclusion Bridging anticoagulation increases the length of postoperative hospital stay, but for patients with high risk factors for embolization, it is more beneficial than continuing oral warfarin during the perioperative period. The incidence of bleeding-related complications associated with continued warfarin therapy is significantly higher than that of embolization-related complications, and hemostatic drugs can be given necessarily.
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Objective:To observe short-term therapeutic effect and prognosis of levosimendan or milrinone on patients with decompensated heart failure(DHF).Methods:A total of 120 DHF patients treated in our hospital were equal-ly divided into levosimendan group(received levosimendan based on routine anti-HF treatment)and milrinone group (received milrinone based on routine anti-HF treatment),both groups were treated for one week continuously.Lev-el of brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF)and 6min walking distance(6MWD) were compared between two groups before and after treatment.Results:Compared with before treatment,on one week after treatment,there was significant reduction in BNP level and significant rise in LVEF in two groups,P=0.001 all;compared with milrinone group after one-week treatment,there was significant reduction in BNP level [(224.45 ± 29.45)pg/ml vs.(197.41 ± 27.65)pg/ml]and significant rise in LVEF[(37.72 ± 2.03)% vs.(44.33 ± 1.94)%]in levosimendan group,P=0.001 both.Compared with before treatment after three-month treatment, there was significant rise in 6MWD in two groups(P=0.001),and 6MWD of levosimendan group was significantly longer than that of milrinone group[(441.76 ± 75.45)m vs.(409.63 ± 73.56)m],P=0.02. Conclusion:Short-term therapeutic effect and prognosis of routine anti-HF medication combined levosimendan are significantly better than those of combined milrinone treatment in DHF patients.