ObjectiveTo evaluate the anticoagulation efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) in patients with high-risk atrial fibrillation (AF) undergoing transcatheter aortic valve implantation (TAVI). MethodsA computer-based search was conducted on PubMed, EMbase, The Cochrane Library, CNKI, SinoMed, and VIP databases to identify studies on the application of NOACs and VKAs in high-risk AF patients after TAVI. The search period was from database inception to January 2023. The quality of the included studies was assessed using the Cochrane risk assessment tool and the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.4 software. ResultsA total of 7 studies involving 24 592 patients were included. The meta-analysis results showed that compared to patients using VKAs, those treated with NOACs had a significantly lower risk of all-cause mortality [RR=0.74, 95%CI (0.58, 0.94), P=0.01]. Subgroup analysis indicated that when the follow-up period was less than 1 year, there was no significant difference in all-cause mortality between the NOAC and VKA groups [RR=0.57, 95%CI (0.17, 1.88), P=0.35]; however, when the follow-up period was ≥1 year, the VKA group had a higher all-cause mortality rate than the NOAC group, with a statistically significant difference [RR=0.73, 95%CI (0.57, 0.95), P=0.02]. No significant differences were found between the two groups regarding early stroke [RR=0.50, 95%CI (0.19, 1.28), P=0.15], stroke during follow-up [RR=1.04, 95%CI (0.88, 1.22), P=0.64], bleeding [RR=0.94, 95%CI (0.73, 1.21), P=0.61], major or life-threatening bleeding [RR=0.80, 95%CI (0.49, 1.31), P=0.38], or acute kidney injury [RR=0.51, 95%CI (0.16, 1.59), P=0.24]. Conclusion Compared to VKAs, the use of NOACs in patients with high-risk AF undergoing TAVI may reduce the risk of all-cause mortality, especially during long-term anticoagulation therapy, potentially offering greater benefits. However, further evidence from randomized controlled trials is needed to confirm these findings.
Enhanced recovery after surgery (ERAS) has been proven to reduce surgical injuries, promote recovery, and improve postoperative outcomes in different types of surgeries. A core principle of ERAS is to provide programmatic evidence-based perioperative interventions. An international multidisciplinary expert group provided a statement on clinical practice in each thematic area of ERAS by obtaining a list of potential ERAS elements, and reviewing literature. The version 2024 of "Perioperative care in cardiac surgery: A joint consensus statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and the Society of Thoracic Surgeons (STS)" is developed from the version 2019 of "Guidelines for perioperative care in cardiac surgery: Enhanced Recovery after Surgery Society recommendations". The consensus statement group was composed of multidisciplinary experts such as cardiac surgeons, anesthesiologists, intensive care physicians, and nurses, based on personal ERAS knowledge and experience. This article interprets the changes and new statements in the 2024 consensus, which can provide a foundation for the best perioperative practices for adult cardiac surgery patients.
Objective To systematically evaluate the effect of the timing of left ventricular (LV) unloading on the outcomes of patients with cardiogenic shock (CS) receiving extracorporeal membrane oxygenation (ECMO). MethodsA systematic literature search was conducted in PubMed, EMbase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), SinoMed, and the VIP databases from their inception to February 2025. Literature screening was conducted according to predefined inclusion and exclusion criteria. Two researchers independently assessed the study quality and extracted the data. Patients were divided into an early unloading group and a late unloading group based on the timing of LV unloading. RevMan 5.4 software was used to perform the heterogeneity test and meta-analysis. Results A total of 8 studies involving 2 117 patients were included (1 338 in the early unloading group and 779 in the late unloading group). The meta-analysis showed no statistically significant differences between the two groups in the rates of successful ECMO weaning, in-hospital mortality, or 30-day all-cause mortality (all P>0.05). Compared with the late unloading group, the early unloading group had a lower risk of sepsis [RR=0.79, 95% CI (0.64, 0.96), P=0.02] and abdominal complications [RR=0.67, 95% CI (0.46, 0.96), P=0.03]. ConclusionCompared with late LV unloading, early LV unloading does not significantly improve the successful ECMO weaning rate or early survival. However, early LV unloading is associated with a reduced risk of sepsis and abdominal complications.