Meta-analysis of day-of-week variation of acute aortic rupture or dissection.

INTRODUCTION: We performed a meta-analysis to assess the presence of a day-of-week rhythmic variability of acute aortic rupture or dissection (AARD) onset. EVIDENCE ACQUISITION: Eligible studies were observational studies enrolling patients with AARD and reporting day-of-week variation of AARD. Study-specific estimates, i.e. day-of-week incidence of AARD, were combined using the random-effects model. Chronobiological analysis was performed by applying a partial Fourier series to pooled day-of-week incidence by using the inverse-variance weighted least-squares method. EVIDENCE SYNTHESIS: We identified 9 eligible studies enrolling a total of 28,036 patients with AARD. Pooled incidence of AARD was 12.8% on Sunday, 15.9% on Monday, 14.8% on Tuesday, 15.1% on Wednesday, 14.7% on Thursday, 14.1% on Friday, and 12.1% on Saturday. Chronobiological analysis identified a significant (P=0.0098) day-of-week pattern in the occurrence of AARD with a peak on Monday and a nadir on Saturday. Pooled analysis demonstrated significantly more incidence on Monday than on Saturday (relative risk: 1.247; 95% CI: 1.131 to 1.374; P=0.012). CONCLUSIONS: Incidence of AARD was 12.8%, 15.9%, 14.8%, 15.1%, 14.7%, 14.1%, and 12.1%, on Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, and Saturday, respectively. A significant day-of-week pattern in the occurrence of AARD with a peak on Monday and a nadir on Saturday was identified with significantly more incidence on Monday than on Saturday.

Abdominal Aortic Aneurysm Screening Reduces All-Cause Mortality: Make Screening Great Again.

We performed an updated meta-analysis of the longest (≥13 years) follow-up results from 4 randomized controlled trials of abdominal aortic aneurysm (AAA) screening in ≥64-year-old men. Invitation to screening reduced all-cause mortality significantly according to time-to-event data (hazard ratio: 0.98; 95% confidence interval [CI]: 0.96-0.99; P = .003) despite no reduction according to dichotomous data (odds ratio [OR]: 0.99; 95% CI: 0.96-1.01; P = .23). Invitation to screening reduced AAA-related mortality significantly (OR: 0.66; 95% CI: 0.47-0.93; P = .02) but did not reduce non-AAA-related mortality (OR: 1.00; 95% CI: 0.98-1.02; P = .96). All-cause, AAA-related, and non-AAA-related mortalities were significantly lower in attenders than in nonattenders, in noninvitees, or in both. All-cause (OR: 1.41; 95% CI: 1.23-1.63; P < .00001) and non-AAA-related mortalities (OR: 1.39; 95% CI: 1.18-1.64; P < .0001) were significantly higher in nonattenders than in noninvitees. In conclusion, invitation to AAA screening in ≥64-year-old men reduced both all-cause and AAA-related mortalities significantly. All-cause and non-AAA-related mortalities were significantly higher in nonattenders than in noninvitees, though both did not undergo screening.

Drug-eluting stents versus coronary artery bypass grafting for left-main coronary artery disease.

OBJECTIVES: To compare follow-up outcomes after percutaneous coronary intervention with drug-eluting stents (DES-PCI) versus coronary artery bypass grafting (CABG) for left-main coronary artery disease (LMCAD), we performed a meta-analysis of randomized controlled trials (RCTs) and observational studies with propensity-score analysis. METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through November 2016. Eligible studies were RCTs or observational studies with propensity-score analysis of DES-PCI versus CABG enrolling patients with LMCAD and reporting ≥ 6-month mortality, myocardial infarction (MI), stroke, or repeat revascularization (RRV). Study-specific estimates were combined using inverse variance-weighted averages of logarithmic hazard ratios (HRs) in the random-effects model. RESULTS: We identified 5 RCTs and 17 observational studies with propensity-score analysis enrolling a total of 12,387 patients. Pooled analysis demonstrated a significant increase in a composite of death, MI, and RRV (with/without stroke) after DES-PCI (HR, 1.42; P < 0.00001); no significant difference in a composite of death and MI (with/without stroke); no significant differences in mortality and stroke; a strong trend toward an increase in MI after DES-PCI (HR, 1.44; P = 0.05); and significant increases in any (HR, 1.86; P < 0.00001), target-vessel (HR, 3.28; P < 0.00001), and target-lesion RRV (HR, 2.26; P = 0.003) after DES-PCI. CONCLUSIONS: When compared with CABG, DES-PCI for LMCAD was associated with increases in RRV and the composite of death, MI, and RRV (with/without stroke), despite no differences in mortality, MI, stroke, and the composite of death and MI (with/without stroke).

Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis.

We performed a systematic review and meta-analysis to determine whether perioperative depression and anxiety are associated with increased postoperative mortality in patients undergoing cardiac surgery. MEDLINE and EMBASE were searched through January 2017 using PubMed and OVID, to identify observational studies enrolling patients undergoing cardiac surgery and reporting relative risk estimates (RREs) (including odds, hazard, or mortality ratios) of short term (30 days or in-hospital) and/or late all-cause mortality for patients with versus without perioperative depression or anxiety. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic RREs in the random-effects models. Our search identified 16 eligible studies. In total, the present meta-analysis included data on 236,595 patients undergoing cardiac surgery. Pooled analysis demonstrated that perioperative depression was significantly associated with increased both postoperative early (RRE, 1.44; 95% confidence interval [CI] 1.01-2.05; p = 0.05) and late mortality (RRE, 1.44; 95% CI 1.24-1.67; p < 0.0001), and that perioperative anxiety significantly correlated with increased postoperative late mortality (RRE, 1.81; 95% CI 1.20-2.72; p = 0.004). The relation between anxiety and early mortality was reported in only one study and not statistically significant. In the association of depression with late mortality, there was no evidence of significant publication bias and meta-regression indicated that the effects of depression are not modulated by the duration of follow-up. In conclusion, perioperative depression and anxiety may be associated with increased postoperative mortality in patients undergoing cardiac surgery.

A meta-analysis of weekend admission and surgery for aortic rupture and dissection.

We performed a meta-analysis to determine whether weekend admission and surgery for ruptured abdominal/thoracic aortic aneurysm (RAAA/RTAA) and acute aortic dissection (AAD) is associated with increased mortality. MEDLINE and EMBASE were searched from January 1946 to December 2016 using PubMed and OVID. Eligible studies were prospective or retrospective, comparative or cohort studies enrolling patients admitting or undergoing surgery for RAAA/RTAA/AAD and reporting mortality after weekend (including holiday) versus weekday admission/surgery. Our search identified 11 studies including a total of 166,195 patients. A pooled analysis of 13 adjusted odds ratios (ORs), one adjusted hazard ratio, and one unadjusted OR from all 11 studies demonstrated a statistically significant 32% increase in mortality with weekend admission/surgery (OR, 1.32; 95% confidence interval (CI), 1.20 to 1.45; p < 0.00001). Despite possible publication bias disadvantageous to weekend admission/surgery based on funnel plot asymmetry, adjustment for the asymmetry using the trim-and-fill method did not alter the significant association of weekend admission/surgery with increased mortality (OR, 1.21; 95% CI, 1.09 to 1.34; p = 0.0006). In conclusion, weekend admission/surgery for ruptured abdominal/thoracic aortic aneurysm and acute aortic dissection (AAD) may be associated with increased mortality.

Seizures associated with tranexamic acid for cardiac surgery: a meta-analysis of randomized and non-randomized studies.

INTRODUCTION: The aim of this meta-analysis was to assess whether tranexamic acid (TXA) therapy for adult cardiac surgery is associated with an increase in the risk of seizures, and we performed a meta-analysis of randomized controlled trials (RCTs) and non-randomized observational studies. EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through December 2016 using PubMed and OVID. Eligible studies were RCTs and non-randomized observational studies on TXA versus control (no TXA, placebo, or active control such as low-dose TXA, aprotinin, and epsilon aminocaproic acid) enrolling adult patients undergoing cardiac surgery and reporting the postoperative incidence of seizures as an outcome. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic odds ratios (ORs) in the random-effects model. EVIDENCE SYNTHESIS: Of 90 potentially relevant articles screened initially, 16 reports of eligible studies were identified and included. A pooled analysis of all 16 studies (enrolling 45,235 patients) demonstrated that TXA therapy was associated with a statistically significant increase in the seizures incidence (OR=4.13; 95% CI: 2.59 to 6.57; P<0.00001). A subgroup analysis indicated a statistically significant increase in the seizures incidence with TXA therapy in all subgroups of 5 RCTs, 5 adjusted observational studies, and 6 unadjusted observational studies with no statistically significant subgroup differences (P=0.36; I2=1.5%). CONCLUSIONS: The results of the present meta-analysis of 16 studies enrolling 45,235 patients confirmed that TXA therapy for adult cardiac surgery is associated with a 4.1-fold increase in the risk of seizure.

Association of Hypertension with Abdominal Aortic Aneurysm Expansion.

BACKGROUND: Hypertension is positively associated with abdominal aortic aneurysm (AAA) presence, which supports a hypothesis that hypertension may also be positively associated with AAA expansion. To determine whether hypertension is associated with AAA expansion, we reviewed currently available studies with a systematic literature search and meta-analytic estimate. METHODS: Databases including MEDLINE and EMBASE were searched through July 2015 using Web-based search engines (PubMed and OVID). Studies considered for inclusion met the following criteria: the study population was AAA patients with and without hypertension, and outcomes included data regarding AAA expansion. For each study, expansion rates in both the hypertensive and nonhypertensive groups were used to generate standardized mean differences (SMDs) and 95% confidence intervals (CIs). RESULTS: Of 614 potentially relevant publications screened initially, we identified 20 eligible studies including data on 6,619 AAA patients. No individual study indicated a statistically significant (positive or negative) association of hypertension with AAA expansion rates. A pooled analysis of all the 20 studies demonstrated that hypertension was not associated with AAA expansion rates in the fixed-effect model (SMD 0.03, 95% CI -0.01 to 0.17, P = 0.19). There was no evidence of significant publication bias. CONCLUSIONS: Hypertension is not associated with AAA expansion. Further investigations would be required to elucidate why hypertension is not associated with AAA expansion despite its positive association with AAA presence.

Better midterm survival in women after transcatheter aortic valve implantation.

INTRODUCTION: In previous meta-analyses demonstrating better midterm overall survival in women undergoing transcatheter aortic valve implantation (TAVI), unadjusted risk and odds ratios were combined. To determine whether female gender is independently associated with better survival after TAVI, we performed a meta-analysis pooling adjusted hazard ratios (HRs) based on multivariate Cox proportional hazard regression. EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through September 2015 using PubMed and OVID. Studies considered for inclusion met the following criteria: the study population was patients undergoing TAVI; and main outcomes included midterm (mean or median ≥6 months) overall survival or all-cause mortality in women and men. An unadjusted and/or adjusted HR of all-cause mortality for women versus men was abstracted from each individual study. EVIDENCE SYNTHESIS: Of 1347 potentially relevant articles screened initially, 16 reports of eligible studies were identified and included. A primary meta-analysis of the 9 adjusted HRs demonstrated a significantly better midterm overall survival in women than men (N.=6891; HR=0.80; 95% confidence interval [CI]: 0.65 to 0.97; P=0.03). A secondary meta-analysis adding 5 statistically non-significant unadjusted HR also indicated better survival in women (N.=8645; HR=0.83; 95% CI: 0.72 to 0.96; P=0.01). Although statistical tests for the primary meta-analysis revealed funnel plot asymmetry in favor of women, the secondary meta-analysis produced a symmetrical funnel plot. CONCLUSIONS: Female gender may be independently associated with better midterm overall survival after TAVI.

"Obesity paradox" in transcatheter aortic valve implantation.

BACKGROUND: To determine whether body mass index (BMI) is associated with mortality in transcatheter aortic valve implantation (TAVI), we performed a mete-analysis of currently available studies. METHODS: MEDLINE and EMBASE were searched through September 2015 using PubMed and OVID, to identify all studies investigating an association of BMI with early (in-hospital or 30-day) and mid-term (mean or median follow-up of approximately >6-month) mortality in patients undergoing TAVI. RESULTS: Our search identified 11 eligible studies including 10,196 patients undergoing TAVI. A pooled analysis of 7 studies (enrolling 4046 patients) reporting a hazard ratio (HR) of BMI as continuous data for mid-term mortality demonstrated that greater BMI was associated with significantly less mid-term mortality (HR per 1-unit increase in BMI, 0.97; 95% confidence interval [CI], 0.94 to 1.00 [0.9982]: P = 0.04). Comparisons of overweight versus normal weight and obesity versus normal weight for mid-term mortality were not statistically significant. A pooled analysis of 3 studies (enrolling 3901 patients) reporting an odds ratio (OR) of BMI as continuous data for 30-day mortality demonstrated that greater BMI was associated with significantly less mortality (OR per 1-unit increase in BMI, 0.95; 95% CI, 0.92 to 0.98: P = 0.001). Comparisons of overweight versus normal weight (P = 0.02) and obesity versus normal weight (P = 0.04) for 30-day mortality were statistically significant. CONCLUSIONS: BMI as continuous data may be associated with better early and mid-term post-TAVI survival. Whereas, overweight or obesity as categorized BMI may be associated with early, not mid-term, post-TAVI survival.

A review of comparative studies of MitraClip versus surgical repair for mitral regurgitation.

OBJECTIVES: We summarized comparative studies of MitraClip versus surgical repair for mitral regurgitation (MR) with a systematic literature search and meta-analytic estimates. METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through June 2016. Eligible studies were randomized controlled or observational comparative studies of MitraClip versus surgical repair enrolling patients with MR and reporting early (30-day or in-hospital) or late (≥6-month including early) all-cause mortality. For each study, data regarding all-cause mortality and incidence of recurrent >2+ MR in both groups were used to generate odds ratios (ORs). Alternatively, ORs or hazard ratios (HRs) for mortality and recurrent MR themselves were directly abstracted from each study. RESULTS: Eight reports of 7 studies comparing MitraClip with surgical repair enrolling a total of 1015 patients with MR were identified and included. Pooled analyses demonstrated significantly higher age and logistic European System of Cardiac Operative Risk Evaluation and significantly lower ejection fraction in the MitraClip than surgical repair group, no significant difference in rate of women and patients with New York Heart Association functional class of >II, no statistically significant difference in early- (OR, 0.54; p=0.08) and late-mortality (HR/OR, 1.17; p=0.46), and significantly higher incidence of recurrent MR in the MitraClip than surgical repair group (HR/OR, 4.80; p<0.00001). CONCLUSIONS: In patients with MR, the MitraClip procedure achieves similar survival to surgical MV repair despite higher risk profiles. Recurrent MR, however, occurs more frequently (4.8-fold) after the MitraClip than surgical repair.

Association of peripheral artery disease with abdominal aortic aneurysm growth.

OBJECTIVE: To determine whether an association of peripheral artery disease (PAD) with abdominal aortic aneurysm (AAA) growth is positive, none, or negative, a meta-analysis of all available studies was performed through a systematic literature search. METHODS: MEDLINE and Embase databases were searched until July 2015 by the use of PubMed and Ovid Web-based search engines. The search terms were enlargement, expansion, growth, or progression; and abdominal aortic aneurysm. Studies that fulfilled the following criteria were included: (1) AAA patients with PAD and those without PAD as the population and (2) data of AAA growth as the outcomes. By means of growth rates in patients with and without PAD for each study, we generated standardized mean differences (SMDs) and their 95% confidence intervals (CIs). RESULTS: Of 612 initially screened publications that were potentially relevant, 11 eligible studies that reported the correlation between PAD and AAA growth were identified, and a total of 4573 patients with AAA were included. A pooled analysis of the 11 studies demonstrated a statistically significant association of PAD with lower growth rates of AAA (SMD, -0.18; 95% CI, -0.25 to -0.11; P < .00001). In addition, separately combining seven adjusted effect estimates did not substantively alter the pooled estimate (SMD, -0.17; 95% CI, -0.25 to -0.09; P < .0001). No significant publication bias was observed. CONCLUSIONS: PAD is likely negatively associated with AAA growth. Further research is required to explain why PAD negatively correlates with AAA growth despite a positive correlation with AAA presence.

A Meta-Analysis of the Association of Chronic Obstructive Pulmonary Disease with Abdominal Aortic Aneurysm Presence.

BACKGROUND: Several case-control and population-based abdominal aortic aneurysm (AAA) screening studies have reported inconclusive results of the association of chronic obstructive pulmonary disease (COPD) with AAA presence. To determine whether COPD is associated with AAA presence, we performed a meta-analysis of contemporary clinical studies. METHODS: To identify all contemporary case-control and population-based AAA screening studies evaluating the association of COPD with AAA presence, databases including MEDLINE and EMBASE were searched from January 2000 to May 2015 using Web-based search engines (PubMed and OVID). An adjusted odds ratio (OR) and 95% confidence intervals (CI) for COPD or AAA presence (using multivariable logistic regression) were abstracted from each individual study. We took an OR for AAA presence to be representative of an OR for COPD presence. RESULTS: Of 159 potentially relevant articles screened initially, there were 7 case-control and 4 population-based AAA screening studies that met eligibility requirements and were included. Pooled analysis of all the 11 studies (14 estimates, 155,731 participants), 7 case-control studies (4171 participants), and 4 population-based AAA screening studies (7 estimates, 151,560 participants) respectively demonstrated a statistically significant 1.78-fold (OR 1.78, 95% CI 1.38-2.30, P < 0.00001), 3.05-fold (OR 3.05, 95% CI 1.44-6.49, P = 0.004), and 1.24-fold (OR 1.24, 95% CI 1.04-1.48, P = 0.02) increased prevalence/incidence of COPD in patients with AAA relative to subjects without AAA (i.e., a statistically significant 1.78-, 3.05-, and 1.24-fold increased prevalence/incidence of AAA in patients with COPD relative to subjects without COPD) (P for subgroup differences = 0.02). CONCLUSION: The present meta-analysis demonstrated 1.8-fold increased prevalence/incidence of COPD in patients with AAA relative to subjects without AAA (i.e., 1.8-fold increased prevalence/incidence of AAA in patients with COPD relative to subjects without COPD), which suggests that COPD is associated with AAA presence.

Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Implantation.

BACKGROUND: We reviewed currently available studies that investigated prosthesis-patient mismatch (PPM) in transcatheter aortic valve implantation (TAVI) with a systematic literature search and meta-analytic estimates. METHODS: To identify all studies that investigated PPM in TAVI, MEDLINE and EMBASE were searched through August 2015. Studies considered for inclusion met the following criteria: the study population included patients undergoing TAVI and outcomes included at least post-procedural PPM prevalence. We performed three quantitative meta-analyses about (1) PPM prevalence after TAVI, (2) PPM prevalence after TAVI versus surgical aortic valve replacement (SAVR), and (3) late all-cause mortality after TAVI in patients with PPM versus patients without PPM. RESULTS: We identified 21 eligible studies that included data on a total of 4,000 patients undergoing TAVI. The first meta-analyses found moderate PPM prevalence of 26.7%, severe PPM prevalence of 8.0%, and overall PPM prevalence of 35.1%. The second meta-analyses of six studies, including 745 patients, found statistically significant reductions in moderate (p = 0.03), severe (p = 0.0003), and overall (p = 0.02) PPM prevalence after TAVI relative to SAVR. The third meta-analyses of five studies, including 2,654 patients, found no statistically significant differences in late mortality between patients with severe PPM and patients without PPM (p = 0.44) and between patients with overall PPM and patients without PPM (p = 0.97). CONCLUSIONS: Overall, moderate, and severe PPM prevalence after TAVI was 35%, 27%, and 8%, respectively, which may be less than that after SAVR. In contrast to PPM after SAVR, PPM after TAVI may not impair late survival.

A Meta-Analysis of Total Arch Replacement With Frozen Elephant Trunk in Acute Type A Aortic Dissection.

OBJECTIVES: To assess the safety and efficacy, we performed a meta-analysis of total arch replacement with frozen elephant trunk in exclusive acute type A (neither chronic nor type B) aortic dissection. METHODS: Databases including MEDLINE and EMBASE were searched through March 2015 using Web-based search engines (PubMed and OVID). Eligible studies were case series of frozen elephant trunk enrolling patients with acute type A (neither chronic nor type B) aortic dissection reporting at least early (in-hospital or 30-day) all-cause mortality. Study-specific estimates were combined in both fixed- and random-effect models. RESULTS: Fifteen studies enrolling 1279 patients were identified and included. Pooled analyses demonstrated the cardiopulmonary bypass time of 207.1 (95% confidence interval [CI], 186.1-228.1) minutes, aortic cross-clamp time of 123.3 (95% CI, 113.1-133.5) minutes, selective antegrade cerebral perfusion time of 49.3 (95% CI, 37.6-61.0) minutes, hypothermic circulatory arrest time of 39.0 (95% CI, 30.7-47.2) minutes, early mortality of 9.2% (95% CI, 7.7-11.0%), stroke of 4.8% (95% CI, 2.5-9.0%), spinal cord injury of 3.5% (95% CI, 1.9-6.6%), mid- to long-term (≥1-year) overall mortality of 13.0% (95% CI, 10.4-16.0%), reintervention of 9.6% (95% CI, 5.6-15.8%), and false lumen thrombosis of 96.8% (95% CI, 90.7-98.9%). CONCLUSIONS: Total arch replacement with frozen elephant trunk provides a safe alternative to that with conventional elephant trunk in patients with acute type A aortic dissection, with acceptable early mortality and morbidity. The rates of mid- to long-term reintervention and false lumen non-thrombosis may be lower in patients undergoing the frozen than conventional elephant trunk procedure.

Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies.

OBJECTIVES: To determine which improves clinical outcomes more, sutureless (including rapid-deployment) aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of comparative studies. METHODS: MEDLINE and EMBASE were searched through June 2015 using Web-based search engines (PubMed and OVID). Studies considered for inclusion met the following criteria: the design was a comparative study; the study population included patients with severe aortic valve stenosis, patients were assigned to sutureless AVR versus TAVI; and main outcomes included at least early (in-hospital or 30-day) all-cause mortality. RESULTS: Of 87 potentially relevant articles screened initially, no randomized controlled trials and 7 observational comparative studies of sutureless AVR versus TAVI (enrolling a total of 945 patients) were identified and included. The first pooled analysis demonstrated a statistically significant reduction in mortality with sutureless AVR over TAVI [2.5% versus 7.3%; odds ratio (OR), 0.33; 95% confidence interval (CI), 0.16 to 0.69; p=0.003; risk difference (RD), -5.23%; 95% CI, -8.12% to -2.33%; p=0.0004]. The second pooled analyses demonstrated no statistically significant difference in bleeding complications, acute kidney injury, and conduction disturbance between sutureless AVR and TAVI. The third pooled analysis demonstrated a statistically significant reduction in paravalvular aortic regurgitation (AR) with sutureless AVR over TAVI (3.5% versus 33.2%; OR, 0.09; 95% CI, 0.05 to 0.16, p<0.00001; MD, -22.56%; 95% CI, -36.59% to -8.53%; p=0.002). CONCLUSIONS: Compared with TAVI, sutureless AVR may be associated with a reduction in early mortality and postoperative paravalvular AR.

Overweight, but not obesity, paradox on mortality following coronary artery bypass grafting.

OBJECTIVES: To determine whether an "obesity paradox" on post-coronary artery bypass grafting (CABG) mortality exists, we abstracted exclusively adjusted odds ratios (ORs) and/or hazard ratios (HRs) for mortality from each study, and then combined them in a meta-analysis. METHODS: MEDLINE and EMBASE were searched through April 2015 using PubMed and OVID, to identify comparative studies, of overweight or obese versus normal weight patients undergoing CABG, reporting adjusted relative risk estimates for short-term (30-day or in-hospital) and/or mid-to-long-term all-cause mortality. RESULTS: Our search identified 14 eligible studies. In total our meta-analysis included data on 79,140 patients undergoing CABG. Pooled analyses in short-term mortality demonstrated that overweight was associated with a statistically significant 15% reduction relative to normal weight (OR, 0.85; 95% confidence interval [CI], 0.74-0.98; p=0.03) and no statistically significant differences between mild obesity, moderate/severe obesity, or overall obesity and normal weight. Pooled analyses in mid-to-long-term mortality demonstrated that overweight was associated with a statistically significant 10% reduction relative to normal weight (HR, 0.90; 95% CI, 0.84 to 0.96; p=0.001); and no statistically significant differences between mild obesity, moderate/severe obesity, or overall obesity and normal weight. CONCLUSIONS: Overweight, but not obesity, may be associated with better short-term and mid-to-long-term post-CABG survival relative to normal weight. An overweight, but not obesity, paradox on post-CABG mortality appears to exist.

Similar Survival After Repair vs Replacement for Ischemic Mitral Regurgitation.

To determine whether mitral valve (MV) repair improves early and late survival compared with MV replacement for patients with ischemic mitral regurgitation (IMR), we performed a meta-analysis of randomized controlled trials (RCTs) and adjusted observational studies. Databases including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through January 2016 using PubMed and Ovid. Studies considered for inclusion met the following criteria: the design was a RCT or adjusted observational study, the study population was patients with IMR; patients were assigned to MV repair vs replacement, and outcomes included early (30 days or in hospital) or late (≥1 year) overall survival or all-cause mortality. An adjusted odds or hazard ratio (OR/HR) with its 95% CI of early or late (including early) all-cause mortality for MV repair vs replacement was abstracted from each individual study. Our search identified 12 articles from one RCT and 10 adjusted observational studies including 2784 patients. Pooled analyses demonstrated no significant difference in both early (OR = 0.90; 95% CI: 0.69-1.16; P = 0.41) and late mortality (HR = 0.90; 95% CI: 0.72-1.13; P = 0.38) between MV repair and replacement. Exclusion of any single study from the meta-analysis did not substantively alter the overall result of no significant difference. There was no evidence of significant publication bias. For patients with IMR, MV repair appears to be unassociated with a significant decrease in both early and late all-cause mortality compared with MV replacement.

A Meta-Analysis of Sutureless or Rapid-Deployment Aortic Valve Replacement.

Objective To summarize the safety of sutureless or rapid-deployment aortic valve replacement (AVR), we performed a systematic review and meta-analysis of single-arm studies. Methods MEDLINE and EMBASE were searched through December 2014. Studies considered for inclusion met the following criteria: the design was a single-arm study enrolling ≥50 participants; the study population consisted of patients undergoing sutureless/rapid-deployment AVR; and main outcomes included early (in-hospital or 30-day) mortality and/or overall survival. Results Of 250 potentially relevant articles screened initially, 11 eligible studies enrolling a total of 2,066 patients were identified and included. The Enable, Intuity, and Perceval bioprostheses were used in three, two, and six studies, respectively. Mean age of patients was 77.6 years, and 56.9% of patients were women. Mean logistic European System for Cardiac Operative Risk Evaluation I and II were 10.5 and 7.4%, respectively. Aortic cross-clamp times in overall patients, patients undergoing isolated AVR, those undergoing AVR with any concomitant procedures, and those undergoing AVR with coronary artery bypass grafting were 44.7, 41.9, 56.2, and 51.3 minutes, respectively. Arithmetic mean of early mortality was 2.6%, and fixed-effects combined early mortality was 3.2% (95% confidence interval, 2.5-4.2%). Arithmetic mean of 1-year survival was 89.7%, and fixed-effects combined 1-year mortality was 10.4% (9.0-12.1%). Conclusion Sutureless/rapid-deployment AVR is feasible and safe with approximate 3 and 10% of early and 1-year mortality, respectively. Large-size randomized controlled trials, however, are needed to determine whether sutureless/rapid-deployment AVR improves mortality compared with conventional AVR.

Simple renal cyst and abdominal aortic aneurysm.

OBJECTIVE: To summarize the association of simple renal cyst (SRC) with abdominal aortic aneurysm (AAA), we reviewed currently available clinical studies with a systematic literature search and meta-analytic evaluation. METHODS: To identify all case-control studies evaluating the association of SRC with AAA, databases including MEDLINE and Embase were searched through April 2015 using web-based search engines (PubMed and Ovid). For each study, data regarding SRC prevalence in both the AAA and control groups were used to generate unadjusted odds ratios (ORs) and 95% confidence intervals. When an adjusted OR (by the use of multivariable logistic regression) was available, we preferentially abstracted the adjusted OR rather than an unadjusted OR. RESULTS: Of 139 potentially relevant articles screened initially, 5 eligible case-control studies enrolling a total of 2897 participants were identified and included. A pooled analysis of seven estimates from the five studies demonstrated a statistically significant 2.54-fold prevalence of SRC in patients with AAA relative to subjects without AAA (OR, 2.54; 95% confidence interval, 1.93-3.34; P < .00001). CONCLUSIONS: Our meta-analytic evaluation demonstrated 2.5-fold prevalence of SRC in patients with AAA relative to subjects without AAA, which suggests that SRC is associated with AAA.