Clinical outcomes between direct oral anticoagulants versus vitamin K antagonists in chronic thromboembolic pulmonary hypertension: A systematic review and meta-analysis.

Pulmonary hypertension (PH) is a known chronic condition that can lead to increased morbidity and mortality. Patients who develop PH due to thromboembolic disease are catalogued as chronic thromboembolic pulmonary hypertension (CTEPH). Anticoagulation remains a topic of interest in these patients. PUBMED, EMBASE and COCHRANE databases were searched by two investigators until December 2023. Information was analyzed for all-cause mortality, venous thromboembolism and major bleeding. We included a total of 10 studies in this meta-analysis. Our pooled analysis demonstrated that DOACs were non-inferior in all-cause mortality [OR 0.88, 95 % CI (0.48, 1.61)], venous thromboembolism [OR 1.00, 95 % CI (0.50, 1.98)] and major bleeding [OR 0.78, 95 % CI (0.43, 1.40)] when compared to VKAs. In conclusion, our meta-analysis supports the use of DOACs in patients with CTEPH. Further randomized trials are still needed to confirm our results in terms of safety and mortality.

Transcatheter Vacuum-Assisted Mass Extraction Versus Surgical Debridement for Vegetations in Tricuspid Valve Infective Endocarditis: A Meta-Analysis of Observational Studies.

Tricuspid valve infective endocarditis (TVIE), often associated with vegetation in people who inject drugs, has introduced a less invasive option for vegetation removal: transcatheter vacuum-assisted mass extraction (TVME). This technique is emerging as an alternative to standard surgical debridement (SD) and valve repair. However, the comparative effectiveness of TVME versus SD in treating TVIE has yet to be investigated. A comprehensive systematic literature search was performed on PubMed, Embase, and Cochrane to identify all relevant studies comparing TVME with SD in patients with TVIE. The search covered studies from inception up to August 15, 2023. For data analysis, Review Manager (RevMan) 5.4 software was employed, using a random-effects model to calculate risk ratios (RRs), mean differences, and 95% confidence intervals (CIs). Five studies included a total of 431 patients (244 in the TVME arm and 187 in the SD arm). In-hospital mortality (p = 0.72), procedural mortality (p = 0.77), 30-day mortality (p = 0.25), and 1-year mortality (p = 0.44) insignificantly favored SD over TVME. Overall mortality across the 5 studies insignificantly favored TVME over SD (RR = 0.66, 95% CI 0.31 to 1.39, p = 0.27, I2 = 57%). When addressing heterogeneity by excluding 1 study, no statistical significance in the difference between the 2 arms regarding overall mortality was observed (RR 0.99, 95% CI 0.60 to 1.63, p = 0.97, I2 = 0%). This meta-analysis of the 5 observational studies found no significant difference in overall mortality between TVME and SD for the treatment of TVIE. However, prospective randomized controlled trials are necessary to further understand and compare the outcomes of these 2 approaches.

Pulmonary Artery Denervation as a New Therapeutic Option for Pulmonary Hypertension: A Systematic Review and Meta-Analysis.

Pulmonary hypertension (PH) is a progressive disease with a high morbidity and mortality. The treatment is based on the type of PH. Prognosis still remains poor despite the use of different medications. Pulmonary artery denervation (PADN) has been studied as a novel therapeutic option in these patients. PUBMED, EMBASE and COCHRANE databases were searched by 2 investigators until January 2023. Information was analyzed for the following outcomes: 6-minute walk distance (6MWD), mean pulmonary artery pressure, pulmonary vascular resistance and cardiac output. Subgroup analysis comparing pre and post PADN in different PH groups was done. Statistical analysis was performed with the Review Manager version 5.4. This meta- analysis included 6 controlled trials and 6 single-arm prospective studies with a total of 616 patients. Our pooled analysis showed a significant reduction in mean pulmonary artery pressure [WMD -6.51, 95% CI (-9.87, -3.15), p = 0.0001], pulmonary vascular resistance [WMD -3.69, 95% CI (-6.74, -0.64), p = 0.02] and increased cardiac output [WMD -0.37, 95% CI (0.08, 0.65), p = 0.01]. Subgroup analysis pre and post PADN demonstrated a significant improvement in 6MWD in the WHO group 1 [WMD 99.53, 95% CI (19.60, 179.47), p = 0.01], group 2 [WMD: 69.96, 95% CI (36.40, 103.51), p = < 0.0001] and group 4 [WMD: 99.54, 95% CI (21.80, 177.28), p = 0.01]. This meta-analysis supports PADN as a therapeutic option for patients with PH, regardless of group class. Further randomized trials are still needed to evaluate safety and efficacy.

Mitral Valve-in-Valve Versus Repeat Surgical Mitral Valve Replacement in Patients With Failed Mitral Bioprostheses.

Background: Transcatheter mitral valve-in-valve (MViV) replacement has emerged as an alternative to redo surgical mitral valve replacement (redo-SMVR) in patients with failed mitral bioprostheses deemed to be at a high surgical risk. The aim of this analysis was to compare the outcomes of MViV replacement with those of redo-SMVR in patients with a failed bioprosthetic mitral valve. Methods: We performed a study-level meta-analysis that compared MViV replacement with redo-SMVR in patients with failed mitral bioprostheses. Seven observational studies, with a total of 5083 patients, were included (1138 patients [22.4%] in the MViV replacement arm). The primary focus was all-cause mortality. Additional outcomes included major bleeding, stroke, vascular complications, and mean mitral valve gradient at follow-up. Results: The in-hospital mortality was lower in patients who underwent MViV replacement than in those who underwent redo-SMVR (odds ratio [OR], 0.64; 95% CI, 0.53-0.78; P = .0023). The short-term mortality (<1 year) was numerically lower in the MViV replacement group (OR, 0.45; 95% CI, 0.18-1.13; P = .069). At 1 year, the risk of mortality was similar in the 2 groups (OR, 0.99; 95% CI, 0.69-1.40; P = .906), and at midterm follow-up (≥1 year), there was a numerically higher risk of mortality in the MViV replacement group (OR, 1.51; 95% CI, 1.00-2.29; P = .051). The risk of major bleeding was significantly lower in the MViV replacement group (OR, 0.23; 95% CI, 0.10-0.56; P = .01). Additionally, stroke and vascular complications were similar between the 2 groups. Conclusions: The in-hospital mortality was lower in the MViV replacement group than in the redo-SMVR group. There were no differences in mortality at short-term (<1 year), 1-year, or midterm (≥1 year) follow-ups.