RESUMEN
Objective: Ventricular assist device is one of the treatment options for heart failure patients. Therefore, the purpose of this review is to aid in clinical decision-making of exchanging previous older ventricular assist device models to the newest one, HM3. Methods: The search was conducted across several databases until February 25, 2023, and was registered with the ID of CRD42023405367. Risk of bias was performed using Cochrane Risk of Bias 2.0 and the Newcastle Ottawa Scale. In order to rank and evaluate the pooled odds ratios and mean differences with 95% confidence intervals, we employed conventional and Bayesian network meta-analysis converted to surface under the cumulative ranking. Results: A total of 49 studies with 31,105 patients were included in this review. HM3 is the best device exchange choice that causes the lowest risk of mortality (HM3 (99.98) > HM2 (32.43) > HVAD (17.58)), cerebrovascular accidents (HM3 (99.99) > HM2 (42.41) > HVAD (7.60)), other neurologic events beside cerebrovascular accident (HM3 (91.45) > HM2 (54.16) > HVAD (4.39)), pump thrombosis (HM3 (100.00) > HM2 (39.20) > HVAD (10.80)), and bleeding (HM3 (97.12) > HM2 (47.60) > HVAD (5.28)). HM3 is also better than HM2 in hospital admissions (OR: 1.90 (95% CI: 1.15-3.12)). When complications were present, HM2 or Heartware ventricular assist devices exchange to HM3 lowered the mortality rate compared to exchanging it to the same device type. Conclusion: HM3 is the best device for all six outcomes. Exchange from Heartware ventricular assist devices or HM2 to HM3 rather than the same ventricular assist device type is recommended only if a complication is present.
RESUMEN
Atrial fibrillation (AF) ablation is a frequent procedure used in concomitant cardiac surgery. However, uncertainty still exists concerning the optimal extent of lesion sets. Hence, the objective of this study was to assess the results of various ablation techniques, aiming to offer a reference for clinical decision making. This review is listed in the prospective register of systematic reviews (PROSPERO) under ID CRD42023412785. A comprehensive search was conducted across eight databases (Scopus, Google Scholar, EBSCOHost, PubMed, Medline, Wiley, ProQuest, and Embase) up to 18 April 2023. Studies were critically appraised using the Cochrane Risk of Bias 2.0 for randomized control trials (RCTs) and the Newcastle Ottawa Scale adapted by the Agency for Healthcare Research and Quality (AHRQ) for cohort studies. Forest plots of pooled effect estimates and surface under the cumulative ranking (SUCRA) were used for the analysis. Our analysis included 39 studies and a total of 7207 patients. Both bi-atrial ablation (BAA) and left atrial ablation (LAA) showed similar efficacy in restoring sinus rhythm (SR; BAA (77.9%) > LAA (76.2%) > pulmonary vein isolation (PVI; 66.5%); LAA: OR = 1.08 (CI 0.94-1.23); PVI: OR = 1.36 (CI 1.08-1.70)). However, BAA had higher pacemaker implantation (LAA: OR = 0.51 (CI 0.37-0.71); PVI: OR = 0.52 (CI 0.31-0.86)) and reoperation rates (LAA: OR = 0.71 (CI 0.28-1.45); PVI: OR = 0.31 (CI 0.1-0.64)). PVI had the lowest efficacy in restoring SR and a similar complication rate to LAA, but had the shortest procedure time (Cross-clamp (Xc): PVI (93.38) > LAA (37.36) > BAA (13.89)); Cardiopulmonary bypass (CPB): PVI (93.93) > LAA (56.04) > BAA (0.03)). We suggest that LAA is the best surgical technique for AF ablation due to its comparable effectiveness in restoring SR, its lower rate of pacemaker requirement, and its lower reoperation rate compared to BAA. Furthermore, LAA ranks as the second-fastest procedure after PVI, with a similar CPB time.