ABSTRACT
@#Objective To systematically evaluate the safety, efficacy, and economics of intracardiac echocardiography (ICE) versus transesophageal echocardiography (TEE) in left atrial appendage occlusion (LAAO). Methods PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Database were systematically searched to collect relevant studies on comparing ICE and TEE-guided LAAO from inception to June 15th, 2022. Two reviewers independently screened the literatures, extracted the data, and assessed the risk of bias of the included studies. Meta-analyses were performed using RevMan 5.3 and R 4.0.3. Retrospective cohort studies were excluded for sensitivity analysis. Subgroup analyses were performed based on the types of occluder and ICE catheter. Results A total of 14 studies with 6 599 patients were included. Meta-analyses showed no statistical differences in technical success rate, overall complications, device embolization, peri-device leakage, device-related thrombus, stroke, vascular complications, bleeding, operation time, fluoroscopy time, or contrast agent volume between the ICE and TEE-guided LAAO. The total in-room time (MD=–33.47 min, 95%CI –41.20 to –25.73, P<0.000 01) and radiation dosage (MD=–170.20 mGy, 95%CI –309.79 to –30.62, P=0.02) were lower in the ICE group than those in the TEE group, whereas the incidence of pericardial effusion/tamponade was higher than the TEE group (RR=1.57, 95%CI 1.01 to 2.45, P=0.048). Except for pericardial effusion/tamponade, subgroup analyses and sensitivity analysis showed similar results. The analysis based on the cost data from the United States showed comparable or even lower total costs for ICE versus TEE, but comparative domestic cost studies were lacking. Conclusion Current evidence suggests that ICE-guided LAAO can reduce radiation dosage and total in-room time, and there is no statistical difference in the overall complication rate between the two groups. Owing to the limitations of sample size and quality of the included studies, the conclusion still needs to be verified by large sample size and high-quality randomized controlled trials.
ABSTRACT
Objective To assess the outcome of vesicoureteral reflux after augmentation cystoplasty in patients with neurogenic bladder.Methods Between January 2008 and January 2014,a total of 25 patients,with a hypocompliant bladder associated with vesicoureteral reflux confirmed by video-urodynamics preoperatively,were recruited in this study.They all had undergone bladder augmentation with a generous detubularized segment of bowel at our institution.No effort had been made to correct existing reflux.Preoperatively assessment included urinalysis,kidney function tests,ultrasonography,video-urodynamic evaluation.All patients had various degrees of vesicoureteral reflux.The status of vesicoureteral reflux and bladder function were studied by video-urodynamic.Results Mean follow-up was 2.2 years (range 0.5 to 5.5 years).The video-urodynamics manifested a significant improvement of bladder capacity,diminution of intravesical pressure and resolution of reflux after bladder augmentation.Of the 25 patients,20 (80％) no longer had reflux,3 (12％) had improvement,2 (8％) had no change.Sixteen of 18 with grades Ⅰ to Ⅲ (89％),all refluxing units with grade Ⅳ to grade Ⅴ (100％) showed complete cessation of reflux.Symptomatic urinary infection was not found after surgery.Conclusions Augmentation enterocystoplasty without ureteral reimplantation is effective and adequate for patients with high pressure and hypocompliant neurogenic bladder.Therefore,ureteral reimplantation is not necessary underwent when augmentation enterocystoplasty is recommended to patients with neurogenic bladder and vesicoureteral reflux.