Preclinical Large Animal In-Vivo Experiments for Surgically Implanted Atrioventricular Valve: Reappraisal and Systematic Review.

BACKGROUND: The development of atrioventricular bioprosthesis has witnessed an increasing drive toward clinical translation over the last few decades. A significant challenge in the clinical translation of an atrioventricular bioprosthesis from bench to bedside is the appropriate choice of a large animal model to test the safety and effectiveness of the device. METHODS: We conducted a systematic review of pre-clinical in vivo studies that would enable us to synthesize a recommended framework. PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines were followed to identify and extract relevant articles. RESULTS: Sheep was the most common choice of animal, with nine out of the 12 included studies being conducted on sheep. There were acute and chronic studies based on our search criteria. An average of ~20 and 5 animals were used for chronic and acute studies. One out of three acute studies and eight out of nine chronic studies were on stented heart valve bioprosthesis. All analyses were conducted on the implantation of atrioventricular valves with trileaflet, except for one chronic study on unileaflet valves and one chronic and acute study on bileaflet valves. CONCLUSION: Understanding the variance in past pre-clinical study designs may increase the appropriate utilization of large animal models. This synthesized evidence provides a pre-clinical in vivo studies framework for future research on an atrioventricular bioprosthesis.

Impact of avoiding cardioplegic arrest on clinical outcome in patients undergoing CABG in Bangladesh: a systematic review and meta-analysis.

OBJECTIVES: Over the last decade, the practice of surgical revascularization for the coronary artery disease has been popularized in Bangladesh. Our aim was to compare the outcome of non-cardioplegic versus cardioplegic coronary artery bypass surgery in terms of early postoperative outcomes. METHODS: A literature search was conducted in March 2020 on Medline (via PubMed), Scopus and Bangladesh Journal Online electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All randomized controlled trials and observational studies reporting findings of coronary revascularization surgery comparing the outcomes were included. RESULTS: Fifteen studies were used quantitatively that included a total cohort of 4750 coronary artery bypass graft (CABG) patients in Bangladesh. After the meta-analysis, we observed a longer duration of operating time [mean difference (MD): - 52.30, confidence interval (CI): - 67.73 to - 36.86, I 2 18 = 89%, p < 0.00001] and a higher incidence of postoperative atrial fibrillation [risk ratio (RR): 0.43, CI: 0.14 to 0.80, I 2 = 44%, p = 0.01] in the cardioplegic CABG group as compared with the non-cardioplegic group. Additionally, statistically significant longer duration of ventilation time (MD: - 8.64, CI: - 9.47 to - 7.82, I 2 = 82%, p < 0.00001) and ICU stay (MD: - 17.25, CI: - 33.36 to - 1.14, I 2 = 99%, p = 0.04) was observed in the cardioplegic group. No significant differences in number of grafts and in-hospital mortality were found between the two groups. CONCLUSION: Non-cardioplegic CABG may be a viable alternative to cardioplegic CABG in Bangladeshi population, providing similar postoperative outcomes but offering additional advantage of shorter operation and ventilation times.