Objective To systematically review the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) in the treatment of patients with unprotected left main coronary artery disease (ULMCA). Methods Databases including The Cochrane Library (Issue 2, 2012), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to September 2012 for randomized controlled trials on the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) for ULMCA; References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0. Results Four studies were included involving 1 611 cases, of which, 802 cases are in the CABG group, while 809 cases were in the PCI group. The results of meta-analysis showed that: comparing with PCI, CABG significantly reduced the postoperative repeat revascularization rate (OR=0.45, 95%CI 0.31 to 0.66, Plt;0.000 1), but there was no significant difference between the two groups in reducing the myocardial infarction incidence (OR=1.28, 95%CI 0.47 to 3.48, P=0.63), mortality rate (OR=1.36, 95%CI 0.80 to 2.34, P=0.26), and the incidence of major adverse cardio-cerebral vascular events (OR=0.92, 95%CI 0.66 to 1.28, P=0.61). Conclusion This study indicates that CABG is superior to PCI in reducing postoperative rate of target vessel revascularization. But CABG and PCI are alike in reducing myocardial infarction incidence, mortality rate, and the incidence of major adverse cardio-cerebral vascular events. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality RCTs.
Objective To evaluate the effectiveness and security through meta-analysis of a comprehensive study of efficacy of coronary artery bypass grafting (CABG) versus drug-eluting stent percutaneous coronary intervention (DES-PCI), for diabetes mellitus with multi-vessel coronary disease. Methods Databases including The Cochrane Library, PubMed, MEDLINE, EMbase, CBM, CNKI, WanFang Data and VIP were searched from their establishment dates to 2010. Published information and conference papers including references were handsearched. Relevant randomized controlled trials (RCTs) on diabetic patients with coronary multi-vessel disease treated with revascularization were collected and screened by two reviewers independently. After data extraction and quality assessment of the included studies, meta-analysis was performed using RevMan 5.0. Results A total of eight studies involving a total of 3 689 cases (CABG group: 1 814 cases; DES-PCI group: 1 875 cases) were included. Results of meta-analyses showed that: compared with the DES-PCI group, the CABG group could significantly reduce postoperative repeat revascularization rate (OR=0.27, 95% CI 0.10 to 0.69, P=0.006) and major cardio-cerebral vascular events (OR=0.49, 95% CI 0.38 to 0.62, Plt;0.000 01). But in reducing mortality rate (OR=0.84, 95%CI 0.64 to 1.10, P=0.21), cerebrovascular events (OR=2.00, 95%CI 0.97 to 4.14, P=0.06) and myocardial infarction incidence rate (OR=0.92, 95%CI 0.53 to 1.59, P=0.75), there were no significant differences between the two groups. Conclusion CABG is superior to DES-PCI in the treatment of diabetic patients with multi-vessel disease. However, due to the limitation of the quality and quantity of the included studies, the above conclusion should be tested by conducting more large-scale, multi-center and prospective RCTs in future.
Objective To analyze the clinical efficacy of totally thoracoscopic surgery and conventional thoracotomy in repair of ventricular septal defect (VSD). Methods We retrospectively reviewed the clinical data of 50 VSD patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2017. According to the surgical pattern, they were divided into two groups: a totally thoracoscopic surgery group (21 patients, 13 males, 8 females, aged 38.36±10.02 years), and a thoracotomy group (29 patients, 18 males, 11 females, aged 42.36±13.02 years). The operation time, hospital stay, ventilator-assisted time and thoracic drainage were compared between the two groups. Results There was no death in two groups. In the thoracoscopic group the duration of cardiopulmonary bypass (CPB) time and the aortic clamping time were longer than those of the thoracotomy group (P<0.05), but postoperative drainage, patients with postoperative use of blood products and postoperative hospital stay were less (P<0.05). There was no statistically significant difference between the two groups in operation time, postoperative ventilator-assisted time or duration of ICU stay. Conclusion Compared with the conventional thoracotomy, totally thoracoscopic VSD repair with less trauma, quicker recovery and less blood use, is safe and reliable and can be used as a preferred surgical intervention.