Wilasrusmee C, Siribumrungwong B, Horsirimanont S, Poprom N, Jirasiritham J, Thakkinstian A. Clinical results of biologic prosthesis: A systematic review and meta-analysis of comparative studies.
Ann Med Surg (Lond) 2017;
15:26-33. [PMID:
28224036 PMCID:
PMC5304244 DOI:
10.1016/j.amsu.2017.01.018]
[Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/21/2017] [Accepted: 01/21/2017] [Indexed: 11/30/2022] Open
Abstract
Background
Biologic prosthesis (BP) has been reported as a safe alternative to polytetrafluoroethylene (PTFE) in vascular reconstruction. However, efficacy of BP remains controversial. We, therefore, conducted a systematic review to summarize previous available evidences comparing the BP and PTFE in terms of clinical outcomes.
Materials and methods
A literature search of the MEDLINE and Scopus was performed to identify comparative studies reporting outcomes of BP, PTFE, and/or autologous veins graft (VG) in vascular access for hemodialysis or femoropopliteal bypass. The outcome of interest was graft patency. Two reviewers independently extracted data. Meta-analysis with a random-effect model was applied to pool a risk ratio (RR) across studies.
Results
Among 584 articles identified, 11 studies (4 randomized controlled trials (RCT) and 7 cohorts) comprising 2627 patients were eligible for pooling. Seven studies compared BP with PTFE and 3 studies compared PTFE with VG. Among BP vs PTFE, pooling based on 3 RCTs yielded the pooled RR of 1.54 (95% CI: 1.10, 2.16), indicating 54% higher graft patency in VG than PTFE. Adding the 7 cohorts in this pooling yield similar results with the pooled RR of 1.29 (95% CI: 1.15, 1.45). The pooled RR of graft patency for BP vs VG was 0.74 (95% CI, 0.55, 1.00), indicating 26% lower graft patency in BP than VG.
Conclusions
Our first meta-analysis indicated that the biosynthetic prosthesis might be benefit over PTFE by increasing graft patency. An updated meta-analysis or a large scale randomized control trial is required to confirm this benefit.
This study summarized the gap of knowledge of clinical outcome when compare with biologic prosthesis and PTFE.
This first meta-analysis was shown clearly about results and high performance of study were collected.
For the conclusion, high efficacy of alternative treatment was shown, however, further study needed to confirm the results.
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