Objective To systematically evaluate the clinical effect of remote ischaemic preconditioning (RIPC) in selective vascular surgery. Methods PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang Data, VIP and CBM were retrieved to gather relevant literatures. Relevant randomized controlled trials were screened according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.3 software. Results A total of 16 studies were included, involving 1 507 patients. There was no statistical difference between RIPC and non-RIPC in reducing perioperative mortality in elective vascular surgery. There were no statistical differences between the two groups in the incidence of myocardial infarction, kidney injury, postoperative stroke, postoperative length of hospital stay, the total duration of surgery or anesthesia, limb injury, arrhythmia, heart failure or pneumonia. Conclusion For patients undergoing elective vascular surgery, there may no statistical in perioperative mortality and other clinical endpoints between RIPC and non-RIPC patients.
Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods We conducted a computer-based search of databases including CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase and Web of Science from the inception of the databases to June 2023. Two reviewers independently screened articles, extracted data and assessed the quality of the included studies. Meta-analysis was performed using Stata 17.0 software. Results A total of 16 cohort studies with Newcastle-Ottawa Scale score≥7 were included. Meta-analysis results demonstrated that patients with PH who underwent TAVR had significantly higher rates of all-cause mortality at 1 year [OR=2.10, 95%CI (1.60, 2.75), P＜0.01, I2=75%], 30 days [OR=2.09, 95%CI (1.54, 2.83), P＜0.01, I2=33%] and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P＜0.001, I2=41%], compared to those without PH. There was no statistical difference between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation or postoperative renal failure. Subgroup analysis was conducted for some outcome indicators with significant heterogeneity from the aspects of PH measurement methods, PH diagnostic criteria and different PH types, and the results showed that most outcome indicators were subcombined and the direction was consistent with the overall result, and the heterogeneity was significantly reduced. Conclusion PH can significantly increase the 30 days, 1-year, and cardiovascular mortality rates in severe AS patients undergoing TAVR surgery.