BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as...BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.展开更多
BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on pri...BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,and ScienceDirect identified five studies involving 2572 patients(1153 males and 1419 females).The primary outcome was hospital mortality.Secondary outcomes included reintervention rates,acute kidney injury(AKI),ischemic stroke,limb ischemia,and spinal cord ischemia.Odds ratios(OR)with 95%confidence intervals(CI)were calculated using a random-effects model.Heterogeneity was assessed using the I²statistic.RESULTS The primary outcome showed no significant difference between males and females for hospital mortality(OR:1.13,95%CI:0.81-1.59,P=0.47,I2=0).Among secondary outcomes,males had a significantly higher risk of AKI(OR:1.55,95%CI:1.21-2.00,P=0.0006,I²=0).No differences were observed for reintervention rates,ischemic stroke,limb ischemia,or spinal cord ischemia.CONCLUSION Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality,ischemic events,reintervention,and other complications.Future research should explore mechanisms and strategies to optimize outcomes.展开更多
文摘BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.
文摘BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,and ScienceDirect identified five studies involving 2572 patients(1153 males and 1419 females).The primary outcome was hospital mortality.Secondary outcomes included reintervention rates,acute kidney injury(AKI),ischemic stroke,limb ischemia,and spinal cord ischemia.Odds ratios(OR)with 95%confidence intervals(CI)were calculated using a random-effects model.Heterogeneity was assessed using the I²statistic.RESULTS The primary outcome showed no significant difference between males and females for hospital mortality(OR:1.13,95%CI:0.81-1.59,P=0.47,I2=0).Among secondary outcomes,males had a significantly higher risk of AKI(OR:1.55,95%CI:1.21-2.00,P=0.0006,I²=0).No differences were observed for reintervention rates,ischemic stroke,limb ischemia,or spinal cord ischemia.CONCLUSION Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality,ischemic events,reintervention,and other complications.Future research should explore mechanisms and strategies to optimize outcomes.
