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Mathew DM, Khusid E, Lui B, Weber M, Boyer R, White RS, Walsh S. Gaps in literature on enhanced recovery after thoracic surgery: Considering social determinants of health. Am J Surg 2024; 230:111-114. [PMID: 38052670 DOI: 10.1016/j.amjsurg.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/18/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Affiliation(s)
| | - Elizabeth Khusid
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Briana Lui
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Marissa Weber
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Richard Boyer
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
| | - Spencer Walsh
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
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2
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Awad AK, Ahmed A, Mathew DM, Varghese KS, Mathew SM, Khaja S, Newell PC, Okoh AK, Hirji S. Minimally invasive, surgical, and transcatheter aortic valve replacement: A network meta-analysis. J Cardiol 2024; 83:177-183. [PMID: 37611742 DOI: 10.1016/j.jjcc.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has evolved as an alternative to surgical aortic valve replacement (SAVR). In addition to full-sternotomy (FS), recent reports have shown successful minimally-invasive SAVR approaches, including mini-sternotomy (MS) and mini-thoracotomy (MT). This network-meta-analysis (NMA) seeks to provide an outcomes comparison based on these different modalities (MS, MT, TAVR) compared with FS as a reference arm for the management of aortic valve disease. METHODS A comprehensive literature search was performed to identify studies that compared minimally-invasive SAVR (MS/MT) to conventional FS-SAVR, and/or TAVR. Bayesian NMA was performed using the random effects model. Outcomes were pooled as risk ratios (RR) with their 95 % confidence intervals (CIs). Our primary outcomes included 30-day mortality, stroke, acute kidney injury (AKI), major bleeding, new permanent pacemaker (PPM), and paravalvular leak (PVL). We also assessed long-term mortality at the latest follow-up. RESULTS A total of 27,117 patients (56 studies) were included; 10,397 patients had FS SAVR, 9523 had MS, 5487 had MT, and 1710 had TAVR. Compared to FS, MS was associated with statistically-significantly lower rates of 30-day mortality (RR, 0.76, 95%CI 0.59-0.98), stroke (RR, 0.84, 95%CI 0.72-0.97), AKI (RR, 0.76, 95%CI 0.61-0.94), and long-term mortality (RR 0.84, 95%CI 0.72-0.97) at a weighted mean follow-up duration of 10.4 years, while MT showed statistically-significantly higher rates of 30-day PVL (RR, 3.76, 95%CI 1.31-10.85) and major bleeding (RR 1.45; 95%CI 1.08-1.94). TAVR had statistically significant lower rates of 30-day AKI (RR 0.49, 95%CI 0.31-0.77), but showed statistically-significantly higher PPM (RR 2.50; 95%CI 1.60-3.91) and 30-day PVL (RR 12.85, 95%CI 5.05-32.68) compared to FS. CONCLUSIONS MS was protective against 30-day mortality, stroke, AKI, and long-term mortality compared to FS; TAVR showed higher rates of 30-day PVL and PPM but was protective against AKI. Conversely, MT showed higher rates of 30-day PVL and major bleeding. With the emergence of TAVR, the appropriate benchmarks for SAVR comparison in future trials should be the minimally-invasive SAVR approaches to provide clinical equipoise.
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Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Adham Ahmed
- City University of New York School of Medicine, New York, NY, USA
| | - Dave M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | | | - Serena M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | - Sofia Khaja
- City University of New York School of Medicine, New York, NY, USA
| | - Paige C Newell
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Sameer Hirji
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Varghese KS, Ahmed A, Mathew DM, Fusco PJ, Abraham MN. Eutectic mixture of local anesthetics and amethocaine as topical anesthetics in pediatrics: a meta-analysis. Pediatr Res 2024:10.1038/s41390-024-03113-7. [PMID: 38429571 DOI: 10.1038/s41390-024-03113-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Pediatric patients often receive topical anesthesia before skin procedures in the Emergency Department, with EMLA cream and amethocaine gel being common choices. The most effective option remains a subject of debate. OBJECTIVE Our goal was to compare EMLA cream with amethocaine gel in pediatric patients undergoing topical anesthesia, focusing on outcomes: first-attempt cannulation success, child-reported visual analogue scale (VAS) score, parent-reported VAS score, observed pain score, child-reported absence of pain, and child-reported acceptable anesthesia. METHODS A database search for studies comparing EMLA cream and amethocaine gel in pediatric topical anesthesia was conducted. Two reviewers extracted and cross-verified data, with a third ensuring accuracy. Using R software, a pairwise meta-analysis was performed via the Mantel-Haenszel method. Outcomes were pooled as risk ratios or standard mean differences with 95% confidence intervals using the random-effects model. RESULTS Amethocaine gel surpasses EMLA cream in child-reported pain absence and first cannulation success. No significant differences were found in child-reported acceptable anesthesia or observed pain scores. Similarly, child- and parent-reported VAS scores showed no variations between EMLA and amethocaine. CONCLUSION This analysis favors amethocaine gel for pediatric topical anesthesia. Further large randomized trials comparing EMLA cream and amethocaine gel in pediatric patients are warranted. IMPACT Procedural pain is a major concern for pediatric patients, their families, and physicians. Topical anesthesia is routinely given prior to children undergoing skin-related procedures in the Emergency Department. In pediatric patients, topical anesthetics such as eutectic mixture of local anesthetics cream and amethocaine gel have proved to be pioneering in pain reduction, but the most effective method is often disputed. Presently, this is the most comprehensive pooled analysis of trials comparing EMLA cream and amethocaine gel in pediatric patients undergoing topical anesthesia. Amethocaine performed better with regards to child-reported absence of pain and first attempt cannulation success.
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Affiliation(s)
| | | | | | | | - Mabel N Abraham
- The Feinstein Institutes for Medical Research, New Hyde Park, NY, USA
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Ahmed A, Awad AK, Varghese KS, Sehgal VS, Hisham K, George J, Pandey R, Vega E, Polizzi M, Mathew DM. Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis. Gen Thorac Cardiovasc Surg 2024; 72:95-103. [PMID: 37414971 DOI: 10.1007/s11748-023-01956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The ideal conduit for mitral valve replacement (MVR) remains elusive, particularly among younger patients due to increased life expectancy. We perform a pairwise meta-analysis comparing the use of bioprosthetic valves (BPV) and mechanical mitral valves (MMV) in patients < 70 years old undergoing MVR. METHODS We comprehensively searched medical databases to identify studies comparing the use of BPV and MMV in patients < 70 years old undergoing MVR. Pairwise meta-analysis was performed using the Mantel-Haenszel method in R version 4.0.2. Outcomes were pooled using the random effect model as risk ratios (RR) with their 95% confidence intervals (95% CI). RESULTS 16,879 patients from 15 studies were pooled. Compared to MMV, BPV was associated with significantly higher rates of 30-day mortality (RR 1.53, p = 0.0006) but no difference in 30-day stroke (RR 0.70, p = 0.43). At a weighted mean follow-up duration of 14.1 years, BPV was associated with higher rates of long-term mortality (RR 1.28, p = 0.0054). No difference was seen between the two groups for risk of long-term stroke (RR 0.92, p = 0.67), reoperation(RR 1.72, p = 0.12), or major-bleeding (RR 0.57, p = 0.10) at a weighted mean follow-up duration of 11.7, 11.3, and 11.9 years, respectively. CONCLUSION The use of MMV in patients < 70 undergoing MVR is associated with lower rates of 30-day/long-term mortality compared to BPV. No significant differences were observed for risk of 30-day/long-term stroke, long-term reoperation, and long-term major bleeding. These findings support the use of MMV in younger patients, although prospective, randomized trials are still needed.
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Affiliation(s)
- Adham Ahmed
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA.
| | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Kathryn S Varghese
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Viren S Sehgal
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Kenzy Hisham
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Jerrin George
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Roshan Pandey
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Eamon Vega
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Mia Polizzi
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Dave M Mathew
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
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Mathew DM, Koff BM, Khusid E, Lui B, Bustillo MA, White RS. Enhanced recovery after neurosurgery: gaps in literature regarding social determinants of health. Neurosurg Rev 2024; 47:67. [PMID: 38267658 DOI: 10.1007/s10143-024-02299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Affiliation(s)
| | - Benjamin M Koff
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth Khusid
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Briana Lui
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Maria A Bustillo
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
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Levy KH, Fusco PJ, Salazar-Restrepo SA, Mathew DM, Pandey R, Ahmed S, Varghese KS, Rogando DO, Ahmed A, Ng MK. Unicompartmental knee arthroplasty revised to total knee arthroplasty versus primary total knee arthroplasty: A meta-analysis of matched studies. Knee 2023; 45:1-10. [PMID: 37708740 DOI: 10.1016/j.knee.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/13/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) offers a less invasive alternative to total knee arthroplasty (TKA), but is accompanied by a high revision risk. The aim of our study was to perform a meta-analysis comparing outcomes of UKA revised to TKA versus primary TKA, to assess if UKA is an effective treatment option, despite its potential need for revision. METHODS Studies comparing matched cohorts of patients with UKA revised to TKA versus primary TKA were identified via the PubMed, Ovid EMBASE, and Scopus databases. The following outcome measures were compared between treatment modalities: postoperative reoperation or revision, total complications, range of motion, patient-reported outcome measures, and length of stay. RESULTS Ten studies were included with 1,070 patients: 410 UKA to TKA and 660 primary TKA. At an average follow-up of 5.6 years in the UKA to TKA cohort and 5.7 years in the primary TKA cohort, there were no significant difference in risk of revision (p = 0.81), total complications (p = 0.54), range of motion (p = 0.09), or length of stay (p = 0.31). Both objective and functional Knee Society Score were significantly higher in patients with primary TKA (p < 0.01). However, there was no difference in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) or pain scores (p = 0.13 and p = 0.21, respectively). CONCLUSION UKA revised to TKA produced comparable clinical and patient-reported outcomes to a primary TKA. UKA may be an effective treatment option in unicompartmental arthritis that would allow for improved functionality and satisfaction without the concern of outcomes deteriorating in patients where a revision becomes necessary.
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Affiliation(s)
| | | | | | | | - Roshan Pandey
- CUNY The City College of New York, New York, NY, USA
| | | | | | | | | | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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Mathew DM, Fusco PJ, Varghese KS, Awad AK, Vega E, Mathew SM, Polizzi M, George J, Mathew CS, Thomas JJ, Calixte R, Ahmed A. Opioid-free anesthesia versus opioid-based anesthesia in patients undergoing cardiovascular and thoracic surgery: a meta-analysis and systematic review. Semin Cardiothorac Vasc Anesth 2023; 27:162-170. [PMID: 37300532 DOI: 10.1177/10892532231180227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite their extensive clinical use, opioids are characterized by several side effects. These complications, coupled with the ongoing opioid epidemic, have favored the rise of opioid-free-anesthesia (OFA). Herein, we perform the first pairwise meta-analysis of clinical outcomes for OFA vs opioid-based anesthesia (OBA) in patients undergoing cardiovascular and thoracic surgery. METHODS We comprehensively searched medical databases to identify studies comparing OFA and OBA in patients undergoing cardiovascular or thoracic surgery. Pairwise meta-analysis was performed using the Mantel-Haenszel method. Outcomes were pooled as risk ratios (RR) or standard mean differences (SMD) and their 95% confidence intervals (95% CI). RESULTS Our pooled analysis included 919 patients (8 studies), of whom 488 underwent surgery with OBA and 431 with OFA. Among cardiovascular surgery patients, compared to OBA, OFA was associated with significantly reduced post-operative nausea and vomiting (RR, 0.57; P = .042), inotrope need (RR .84, P = .045), and non-invasive ventilation (RR, .54; P = .028). However, no differences were observed for 24hr pain score (SMD, -.35; P = .510) or 48hr morphine equivalent consumption (SMD, -1.09; P = .139). Among thoracic surgery patients, there was no difference between OFA and OBA for any of the explored outcomes, including post-operative nausea and vomiting (RR, 0.41; P = .025). CONCLUSION Through the first pooled analysis of OBA vs OFA in a cardiothoracic-exclusive cohort, we found no significant difference in any of the pooled outcomes for thoracic surgery patients. Although limited to 2 cardiovascular surgery studies, OFA was associated with significantly reduced postoperative nausea and vomiting, inotrope need, and non-invasive ventilation in these patients. With growing use of OFA in invasive operations, further studies are needed to assess their efficacy and safety in cardiothoracic patients.
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Affiliation(s)
| | | | | | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eamon Vega
- CUNY School of Medicine, New York, NY, USA
| | | | | | - Jerrin George
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | | | | | - Rose Calixte
- Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Ahmed A, Awad AK, Varghese KS, Mathew J, Huda S, George J, Mathew S, Abdelnasser OA, Awad AK, Mathew DM. Minimally Invasive Versus Transcatheter Aortic Valve Replacement: An Updated Meta-Analysis and Systematic Review. Innovations (Phila) 2023; 18:424-434. [PMID: 37658743 DOI: 10.1177/15569845231197224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Transcatheter aortic valve replacement (TAVR) has arisen as a viable alternative to surgery. Similarly, minimally invasive surgical aortic valve replacement (mini-SAVR), such as ministernotomy and minithoracotomy, have also gained interest. We conducted a pairwise meta-analysis to further investigate the efficacy of TAVR versus mini-SAVR. METHODS Medical databases were comprehensively searched for studies comparing TAVR with a mini-SAVR modality, defined as minimally invasive aortic surgery, ministernotomy, minithoracotomy, or rapid-deployment or sutureless SAVR. Random-effects meta-analysis was conducted using the generic inverse variance method. Primary outcomes included 30-day mortality, midterm mortality, 30-day stroke, acute kidney injury (AKI), paravalvular leak (PVL), new permanent pacemaker (PPM), new-onset atrial fibrillation, and postintervention mean and peak valve pressure gradients and were pooled as risk ratio (RR), mean difference (MD), or hazard ratio (HR) with 95% confidence interval (CI). RESULTS A total of 5,071 patients (2,505 mini-SAVR vs 2,566 TAVR) from 12 studies were pooled. Compared with TAVR, mini-SAVR showed significantly lower rates of both 30-day (RR = 0.63, 95% CI: 0.42 to 0.96, P = 0.03) and midterm mortality at 4 years of follow-up (HR = 0.76, 95% CI: 0.67 to 0.87, P < 0.001). Furthermore, mini-SAVR was protective against 30-day PVL (RR = 0.07, 95% CI: 0.04 to 0.13, P < 0.001) and new PPM (RR = 0.25, 95% CI: 0.11 to 0.57, P < 0.001). Conversely, TAVR was protective against 30-day AKI (RR = 1.67, 95% CI: 1.20 to 2.32, P = 0.002) and postinterventional mean gradients (MD = 1.65, 95% CI: 0.25 to 3.05, P = 0.02). No difference was observed for 30-day stroke (RR = 0.84, 95% CI: 0.56 to 1.24, P = 0.38), new-onset atrial fibrillation (RR = 1.79, 95% CI: 0.93 to 3.44, P = 0.08), or postinterventional peak gradients (MD = 3.24, 95% CI: -1.10 to 7.59, P = 0.14). CONCLUSIONS Compared with TAVR, mini-SAVR was protective against 30-day and midterm mortality, 30-day PVL, and new permanent pacemaker, while TAVR patients had lower 30-day AKI. Future randomized trials comparing the efficacy of mini-SAVR approaches with TAVR are needed.
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Affiliation(s)
- Adham Ahmed
- City University of New York School of Medicine, NY, USA
| | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Joshua Mathew
- City University of New York School of Medicine, NY, USA
| | - Shayan Huda
- City University of New York School of Medicine, NY, USA
| | - Jerrin George
- City University of New York School of Medicine, NY, USA
| | - Serena Mathew
- City University of New York School of Medicine, NY, USA
| | | | - Ayman K Awad
- Faculty of Medicine, El-Galala University, Suez, Egypt
| | - Dave M Mathew
- City University of New York School of Medicine, NY, USA
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Ahmed A, Mathew DM, Mathew SM, Awad AK, Varghese KS, Khaja S, Vega E, Pandey R, Thomas JJ, Mathew CS, Ahmed S, George J, Awad AK, Fusco PJ. General Anesthesia Versus Local Anesthesia in Patients Undergoing Transcatheter Aortic Valve Replacement: An Updated Meta-Analysis and Systematic Review. J Cardiothorac Vasc Anesth 2023; 37:1358-1367. [PMID: 37120319 DOI: 10.1053/j.jvca.2023.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/07/2023] [Accepted: 03/06/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVES For patients with aortic stenosis, transcatheter aortic valve replacement (TAVR) offers a less invasive treatment modality than conventional surgical valve replacement. Although the surgery is performed traditionally under general anesthesia (GA), recent studies have described success with TAVR using local anesthesia (LA) and/or conscious sedation. The study authors performed a pairwise meta-analysis to compare the clinical outcomes of TAVR based on operative anesthesia management. DESIGN A random effects pairwise meta-analysis via the Mantel-Haenszel method. SETTING Not applicable, as this is a meta-analysis. PARTICIPANTS No individual patient data were used. INTERVENTIONS Not applicable, as this is a meta-analysis. MEASUREMENTS AND MAIN RESULTS The authors comprehensively searched the PubMed, Embase, and Cochrane databases to identify studies comparing TAVR performed using LA or GA. Outcomes were pooled as risk ratios (RR) or standard mean differences (SMD) and their 95% CIs. The authors' pooled analysis included 14,388 patients from 40 studies (7,754 LA; 6,634 GA). Compared to GA TAVR, LA TAVR was associated with significantly lower rates of 30-day mortality (RR 0.69; p < 0.01) and stroke (RR 0.78; p = 0.02). Additionally, LA TAVR patients had lower rates of 30-day major and/or life-threatening bleeding (RR 0.64; p = 0.01), 30-day major vascular complications (RR 0.76; p = 0.02), and long-term mortality (RR 0.75; p = 0.009). No significant difference was seen between the 2 groups for a 30-day paravalvular leak (RR 0.88, p = 0.12). CONCLUSIONS Transcatheter aortic valve replacement performed using LA is associated with lower rates of adverse clinical outcomes, including 30-day mortality and stroke. No difference was seen between the 2 groups for a 30-day paravalvular leak. These results support the use of minimally invasive forms of TAVR without GA.
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Affiliation(s)
- Adham Ahmed
- City University of New York School of Medicine, New York, NY.
| | - Dave M Mathew
- City University of New York School of Medicine, New York, NY
| | - Serena M Mathew
- City University of New York School of Medicine, New York, NY
| | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Sofia Khaja
- City University of New York School of Medicine, New York, NY
| | - Eamon Vega
- City University of New York School of Medicine, New York, NY
| | - Roshan Pandey
- City University of New York School of Medicine, New York, NY
| | | | | | - Sarah Ahmed
- City University of New York School of Medicine, New York, NY
| | - Jerrin George
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Ayman K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Peter J Fusco
- City University of New York School of Medicine, New York, NY
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Awad AK, Mathew DM, Fusco PJ, Varghese KS, Abdel-Nasser O, Awad AK, Giannaris P, Mathew SM, Ahmed A. Ross procedure versus pulmonary homograft versus mechanical valve versus bioprosthetic valve versus Ozaki procedure for surgical aortic valve replacement: a frequentist network meta-analysis. Egypt Heart J 2023; 75:64. [PMID: 37479872 PMCID: PMC10361932 DOI: 10.1186/s43044-023-00391-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND There has been a resurgence in interest regarding the Ross procedure due to recent publications detailing positive long-term outcomes. Conversely, surgical aortic valve replacement (SAVR) with a pulmonary homograft (PH), mechanical (MV), bioprosthetic (BV), or the Ozaki procedure each has its own technical advantages and disadvantages. Therefore, we performed a network meta-analysis (NMA) comparing other alternatives to Ross procedure. METHODS Medical databases were comprehensively searched for studies comparing the Ross procedure with AVR using a PH, MV, BV, or the Ozaki procedure. Outcomes were pooled as risk ratios (RR) with their 95% confidence intervals (95% CI). RESULTS A total of 7816 patients were pooled for our NMA from 24 studies. Compared to Ross procedure, both BV and MV were associated with significantly higher rates of 30-day mortality of RR (2.37, 95% CI 1.20-4.67) and (1.88 95% CI 1.04-3.40), respectively, with no significant difference regarding PH or Ozaki. However, only MV was associated with a higher risk of 30-day stroke (RR 8.42, 95% CI 1.57-45.23) with no significant difference in the other alternatives, as well as 30-day MI which showed no significant differences between any of the aortic conduits compared to the Ross procedure. Regarding 30-day major bleeding, MV was associated with a higher when compared to the Ross procedure RR (4.58, 95% CI 1.94-10.85), PH was associated with a lower risk of major bleeding with RR (0.35, 95% CI 0.17-0.71), and BV showed no significant difference. With a mean follow-up duration of 8.5 years compared to the Ross procedure, BV, PH, and MV were associated with a higher risk of long-term mortality with RR (1.89, 95% CI 1.38-2.58), (1.38, 95% CI 1.0-1.87), and (1.94, 95% CI 1.52-2.47), respectively, with the Ozaki procedure showed no significant difference. Regarding long-term stroke-with a mean of 6.3-year follow-up duration-there were no significant differences between any of the aortic conduits compared to the Ross procedure. Nevertheless, long-term need for reintervention-with a mean follow-up duration of 17.5 years-was significant of higher risk with both BV and PH with RR (3.28, 95% CI 1.21-8.84) and (2.42, 95% CI 1.05-5.58), respectively, compared to Ross procedure with MV and Ozaki having no significant difference. CONCLUSIONS The Ross procedure is a viable treatment option for patients undergoing SAVR, showing promising outcomes at short- and long-term follow-ups.
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Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dave M Mathew
- City University of New York School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Peter J Fusco
- City University of New York School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Kathryn S Varghese
- City University of New York School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | | | - Ayman K Awad
- Faculty of Medicine, El-Galala University, Suez, Egypt
| | - Peter Giannaris
- City University of New York School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Serena M Mathew
- City University of New York School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Adham Ahmed
- City University of New York School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA.
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Mathew DM, Huda S, Fusco PJ, Mathew J. The token to current anesthesiology residency interviews. Saudi J Anaesth 2023; 17:309-310. [PMID: 37601486 PMCID: PMC10435780 DOI: 10.4103/sja.sja_240_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 08/22/2023] Open
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Mathew DM, Giannaris PS, Varghese KS, Fusco PJ, Ahmed A. Put the patients to sleep, not the students: The importance of targeted anesthesia initiatives in medical school. Saudi J Anaesth 2023; 17:145-146. [PMID: 37260656 PMCID: PMC10228854 DOI: 10.4103/sja.sja_22_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 03/11/2023] Open
Affiliation(s)
- Dave M. Mathew
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, USA
| | | | | | - Peter J. Fusco
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, USA
| | - Adham Ahmed
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, USA
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Mathew DM, Ampatey NA, Aaronson JA, Samuels JD, McCullough D, White RS. The association of race and ethnicity on obstetric patients' COVID-19 outcomes: A summary of current literature. Am J Reprod Immunol 2023; 89:e13698. [PMID: 36991562 DOI: 10.1111/aji.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, evidence suggests racial and ethnic disparities in COVID-19-related outcomes. Given these disparities, it is important to understand how such patterns may translate to high-risk cohorts, including obstetric patients. A PubMed search was performed to identify studies assessing pregnancy, neonatal, and other health-related complications by race or ethnicity in obstetric patients with COVID-19 infection. Forty articles were included in our analysis based on novelty, relevance, and redundancy. These articles revealed that Black and Hispanic obstetric patients present an increased risk for SARS-CoV-2 infection and maternal mortality; racial and ethnic minority patients, particularly those of Black and Asian backgrounds, are at increased risk for hospitalization and ICU admission; racial and ethnic minority groups, in particular Black patients, have an increased risk for mechanical ventilation; Black and Hispanic patients are more likely to experience dyspnea; Hispanic patients showed higher rates of pneumonia; and Black patients present an increased risk of acute respiratory distress syndrome (ARDS). There is conflicting literature on the relationship between race and ethnicity and various pregnancy and neonatal outcomes. Several factors may underly the racial and ethnic disparities observed in the obstetric population, including biological mechanisms and social determinants of health.
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Affiliation(s)
| | | | - Jaime A Aaronson
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Jon D Samuels
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Danielle McCullough
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
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Ahmed A, Varghese KS, Fusco PJ, Mathew DM, Mathew SM, Ahmed S, Rogando DO, Salazar SA, Pandey R, Awad AK, Levy KH, Hernandez M, Calixte R. Coronary Revascularization in Patients With Diabetes: A Meta-Analysis of Randomized Controlled Trials and Propensity-Matched Studies. Innovations (Phila) 2023; 18:29-40. [PMID: 36628960 DOI: 10.1177/15569845221143420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Patients with diabetes have poorer outcomes with coronary artery disease (CAD) and pose a unique clinical population for revascularization. We performed a pairwise meta-analysis of randomized trials (RCTs) and propensity-matched observational studies (PMS) to compare the clinical outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with diabetes. METHODS A comprehensive literature search was performed to identify RCT and PMS studies comparing CABG with PCI in patients with diabetes with concurrent CAD. Studies were pooled using the random-effects model to perform a pairwise meta-analysis. Primary outcomes included long-term all-cause mortality, cardiac mortality, myocardial infarction (MI), major adverse cardiac and cerebrovascular events (MACCE), and repeat revascularization. Meta-regression was used to explore the effects of baseline risk factors on primary outcomes with moderate to high heterogeneity. RESULTS A total of 18 RCTs and 9 PMS with 28,846 patients were included. PCI was associated with increased long-term all-cause mortality (risk ratio [RR] = 1.34, P < 0.001), cardiac mortality (RR = 1.52, P < 0.001), MI (RR = 1.51, P = 0.009), MACCE (RR = 1.65, P < 0.001), and repeat revascularization (RR = 2.48, P < 0.001) compared with CABG. There was no difference in long-term stroke between the 2 groups (RR = 0.95, P = 0.82). At meta-regression, a greater proportion of female patients in studies was associated with a decreased protective benefit for CABG for long-term all-cause mortality but an increased protective benefit for long-term MI and repeat revascularization. CONCLUSIONS Revascularization of patients with diabetes using CABG is associated with significantly reduced long-term mortality, MI, MACCE, and repeat revascularizations. Future studies exploring the influence of gender on revascularization outcomes are necessary to elucidate the ideal treatment modality in patients with diabetes.
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Affiliation(s)
- Adham Ahmed
- City University of New York School of Medicine, New York, NY, USA
| | | | - Peter J Fusco
- City University of New York School of Medicine, New York, NY, USA
| | - Dave M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | - Serena M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | - Sarah Ahmed
- City University of New York School of Medicine, New York, NY, USA
| | - Dillon O Rogando
- City University of New York School of Medicine, New York, NY, USA
| | | | - Roshan Pandey
- City University of New York School of Medicine, New York, NY, USA
| | - Ahmed K Awad
- City University of New York School of Medicine, New York, NY, USA
| | - Kenneth H Levy
- City University of New York School of Medicine, New York, NY, USA
| | | | - Rose Calixte
- Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Ahmed A, Ahmed S, Varghese KS, Mathew DM, Pandey R, Rogando DO, Salazar SA, Fusco PJ, Levy KH. Decellularized versus cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a meta-analysis of short- and long-term outcomes. Egypt Heart J 2021; 73:100. [PMID: 34746974 PMCID: PMC8572935 DOI: 10.1186/s43044-021-00226-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background The ideal conduit for repair of the right ventricular outflow tract (RVOT) during the Ross procedure remains unclear and has yet to be fully elucidated. We perform a pairwise meta-analysis to compare the short-term and long-term outcomes of decellularized versus cryopreserved pulmonary allografts for RVOT reconstruction during the Ross procedure. Main body After a comprehensive literature search, studies comparing decellularized and cryopreserved allografts for patients undergoing RVOT reconstruction during the Ross procedure were pooled to perform a pairwise meta-analysis using the random-effects model. Primary outcomes were early mortality and follow-up allograft dysfunction. Secondary outcomes were reintervention rates and follow-up endocarditis. A total of 4 studies including 1687 patients undergoing RVOT reconstruction during the Ross procedure were included. A total of 812 patients received a decellularized pulmonary allograft, while 875 received a cryopreserved pulmonary allograft. Compared to cryopreserved allografts, the decellularized group showed similar rates of early mortality (odds ratio, 0.55, 95% confidence interval, 0.21–1.41, P = 0.22). At a mean follow-up period of 5.89 years, no significant difference was observed between the two groups for follow-up allograft dysfunction (hazard ratio, 0.65, 95% confidence interval, 0.20–2.14, P = 0.48). Similarly, no difference was seen in reintervention rates (hazard ratio, 0.54, 95% confidence interval, 0.09–3.12, P = 0.49) nor endocarditis (hazard ratio, 0.30, 95% confidence interval, 0.07–1.35, P = 0.12) at a mean follow-up of 4.85 and 5.75 years, respectively. Conclusions Decellularized and cryopreserved pulmonary allografts are associated with similar postoperative outcomes for RVOT reconstruction during the Ross procedure. Larger propensity-matched and randomized control trials are necessary to elucidate the efficacy of decellularized allografts compared to cryopreserved allografts in the setting of the Ross. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-021-00226-w.
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Affiliation(s)
- Adham Ahmed
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA.
| | | | - Kathryn S Varghese
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Dave M Mathew
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | | | - Dillon O Rogando
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | | | - Peter J Fusco
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Kenneth H Levy
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
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