Objective To systematically evaluate the clinical effects of remote ischaemic preconditioning (RIPC) in elective vascular surgery. Methods Electronic searches were conducted in The Cochrane Library, PubMed, EMbase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, and the Chinese Biomedical Literature Database (CBM). Relevant randomized controlled trials (RCTs) were screened according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.3 software. Results A total of 15 studies involving 1,382 patients were included. The meta-analysis results showed no statistically significant difference between RIPC and non-RIPC groups in reducing perioperative mortality in elective vascular surgery. There were also no statistically significant differences between the two groups of vascular surgery patients regarding the incidence of myocardial infarction, renal injury, postoperative stroke, postoperative length of hospital stay, duration of surgery or total anesthesia time, or the incidence of limb injury, arrhythmia, heart failure, and pneumonia. Conclusion For patients undergoing elective vascular surgery, there are no significant differences between RIPC and non-RIPC in terms of perioperative mortality and other clinical endpoint outcomes.
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.