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Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing.

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Presentation on theme: "Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing."— Presentation transcript:

1 Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing heart surgery  Mirosław Gozdek, MD, Wojciech Pawliszak, MD, Wojciech Hagner, MD, PhD, Paweł Zalewski, PhD, Janusz Kowalewski, MD, PhD, Domenico Paparella, MD, PhD, Thierry Carrel, MD, PhD, Lech Anisimowicz, MD, PhD, Mariusz Kowalewski, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 153, Issue 4, Pages e12 (April 2017) DOI: /j.jtcvs Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Flow diagram according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCT, Randomized controlled trial. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Forest plot of the comparison between posterior pericardial drainage (intervention) and control group for prevention of primary endpoint cardiac tamponade after heart surgery. M-H, Mantel-Haenszel; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Forest plot of the comparison between posterior pericardial drainage (intervention) and control group for prevention of death or cardiac arrest after heart surgery. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Forest plot of the comparison between posterior pericardial drainage (intervention) and control group for prevention of early (A) and late (B) pericardial effusion after heart surgery. IV, Inverse variance; CI, confidence interval; M-H, Mantel-Haenszel. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 Forest plot of the comparison between posterior pericardial drainage (intervention) and control group for prevention of postoperative atrial fibrillation after heart surgery. IV, Inverse variance; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

7 Figure 6 Subgroup analysis conducted for the primary endpoint cardiac tamponade stratified by patients' baseline- and procedural characteristics (age, sex, hypertension, diabetes, type of surgery, number of grafts, duration of CPB and crossclamp, and number of patients within the study). OR, Odds ratio; 95% CI, 95% confidence interval; CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; X-clamp, crossclamp. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

8 Figure E1 Publication bias analysis. Funnel plots constructed for studies included in the meta-analysis for the following investigated endpoints: A, cardiac tamponade; B, death or cardiac arrest; C, early pericardial effusion; D, late pericardial effusion; E, postoperative atrial fibrillation; F, pleural effusion with or without intervention; G, pulmonary complications; H, reoperation for bleeding. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

9 Figure E2 Forest plot of the comparison between posterior pericardial drainage (intervention) and control group for the total chest drainage volume expressed as mean difference and 95% CIs. SD, Standard deviation; IV, inverse variance; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

10 Figure E3 Forest plot of the comparison between posterior pericardial drainage (intervention) and control group for the incidence of pleural effusion with or without intervention after heart surgery. M-H, Mantel-Haenszel; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

11 Figure E4 Forest plot of the comparison between posterior pericardial drainage (intervention) and control group for the prevention of pulmonary complications after heart surgery. M-H, Mantel-Haenszel; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

12 Figure E5 Forest plot of the comparison between posterior pericardial drainage (intervention) and control group for the incidence of reoperation for bleeding after heart surgery. M-H, Mantel-Haenszel; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

13 Figure E6 Forest plot of the comparison between posterior pericardial drainage (intervention) and control group for prevention of acute kidney injury after heart surgery. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

14 Figure E7 Forest plot of the comparison between posterior pericardial drainage (intervention) and control group for the length of ICU stay (A) and overall length of hospital stay (B) expressed as mean difference and 95% CIs. SD, Standard deviation; IV, inverse variance; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

15 Figure E8 Sensitivity analysis conducted for the primary endpoint after accounting for studies reporting 0 events. The individual and overall estimates are expressed as risk difference and 95% CIs. M-H, Mantel-Haenszel; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

16 Figure E9 Sensitivity subgroup analysis for the comparison between posterior pericardial drainage (intervention) and control group stratified by operative technique conducted for the primary endpoint. The added total number of patients is greater than 3425 because of exact same control groups in one study.30 IV, Inverse variance; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

17 Figure E10 Sensitivity analysis (influence analysis) for the primary endpoint conducted by deleting each study at a time and repeating the calculations. Analysis shows that no single study has influenced the overall effect of the intervention. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

18 Pericardial effusion often leads to delayed cardiac tamponade after heart surgery.
The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

19 Video 1 Posterior pericardiotomy procedure. The “inverse T” incision is performed by the end of the surgical procedure to the posterior aspect of the pericardium. Attention is given not to dissect the phrenic nerve (to the right from the incision site) and that any bleeding vessels from the pericardiotomy site are clipped or meticulously cauterized. Video available at: The Journal of Thoracic and Cardiovascular Surgery  , e12DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

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