Objective To systematically review the efficacy and safety of minimally invasive direct coronary artery bypass (MIDCAB) grafting versus percutaneous coronary intervention (PCI) for patients with single-vessel disease of the left anterior descending artery (LAD). Methods Databases including The Cochrane Library (Issue 2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to Oct. 2015, to collect randomized controlled trials (RCTs) about MIDCAB versus PCI for single-vessel disease of the LAD. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 10 RCTs including 1 489 patients were included. The results of meta-analysis showed that: compared with the PCI group, the MIDCAB group could significantly reduce the incidence of postoperative target vessel revascularization (OR=0.20，95%CI 0.13 to 2.29，P < 0.000 01), and the incidence of main adverse cardiovascular and cerebrovascular events (MACCE) (OR=0.44, 95%CI 0.33 to 0.58, P < 0.000 01). No significant differences were found between the two groups in total case mortality (OR=1.23, 95%CI 0.83 to 1.83, P=0.31), cardiogenic death (OR=1.12, 95%CI 0.59 to 2.12, P=0.73), and the incidence of postoperative myocardial infarction (OR=2.16, 95%CI 0.83 to 5.59, P=0.11). Conclusion In reducing the incidences of postoperative target vessels again revascularization and MACCE of patients with single-vessel disease of the LAD, MIDCAB is superior to PCI. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.
ObjectiveTo systematically review the long-term efficacy of coronary artery bypass grafting (CABG) versus drug-eluting stent implantation (DES-PCI) for patients with multivessel coronary artery disease. MethodsWe searched The Cochrane Library (Issue 2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP to collect randomized controlled trials (RCTs) about CABG versus DES-PCI for patients with coronary multivessel disease from the inception to October 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.2 software. ResultsA total of seven RCTs, involving 5 723 patients were included. The results of meta-analysis showed that: compared with the DES-PCI group, the CABG group had lower 1-year incidence of target vessel revascularization (OR=0.39, 95%CI 0.31 to 0.48, P<0.000 01), 5-year mortality (OR=0.78, 95%CI 0.65 to 0.94, P=0.008), and 5-year incidence of myocardial infarction (OR=0.46, 95%CI 0.37 to 0.58, P<0.000 01). However, 1-year, 2-year and 5-year incidences of stroke in the CABG group were significantly higher than that in the DES-PCI group (all P values <0.05). ConclusionThe available evidence suggests that CABG is superior to DES-PCI for patients with multivessel coronary artery disease in long-term effects, but CABG could increase the incidence of stroke. Due to the quantity and quality of the included studies, the above conclusions still need to be verified by more high-quality RCTs.
ObjectiveTo systematically review the efficacy and safety of totally thorascopic (TT) and median sternotomy (MS) approaches for atrial septal defect repair (ASDR). MethodsDatabases including The Cochrane Library (Issue 2, 2016), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to June 2016, to collect randomized controlled trials or cohort studies about TT vs. MS approaches for ASDR. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 11 cohort studies involving 687 patients were included with 305 patients in the TT group, and 382 patients in the MS group. The results of meta-analysis showed that: The TT group had shorter postoperative ventilation time (MD=-1.49, 95%CI -2.27 to -0.71, P=0.000 2), postoperative ICU stay time (MD=-7.30, 95%CI -12.07 to -2.53, P=0.003), hospital stay time (MD=-2.06, 95%CI -2.80 to -1.32, P<0.000 01) and less postoperative drainage (MD=-199.83, 95%CI -325.96 to -73.70, P=0.002) than the MS group. But the bypass time (MD=9.42, 95%CI 1.55 to 17.30, P=0.02) and aortic clamping time (MD 6.78, 95%CI 3.48 to 10.07, P<0.000 1) of the TT group were significantly longer than those of the MS group. ConclusionCompared with MS, TT can significantly reduce the length of postoperative ventilation, postoperative ICU stay, hospital stay and postoperative drainage. But there are risks of prolonged bypass time and aortic clamping time in the TT group. Due to the quantity and quality of the included studies, the above conclusions still needs to be verified by carrying out more studies.