Objectives To compare biological versus mechanical aortic valve replacement. Methods We searched MEDLINE, Scopus, and Cochrane Library databases for randomized clinical trials and propensity-score matched studies published by October 14th, 2021 according to PRISMA statement. Individual patient data on overall survival were extracted. One- and two-stage survival analyses, and random-effects meta-analyses were conducted Results 25 studies were identified, incorporating 8,721 bioprosthetic and 8,962 mechanical valves:. In the one-stage meta-analysis, mechanical valves cumulatively demonstrated decreased hazard for mortality (Hazard Ratio [HR] : 0.79, 95% Confidence interval [CI] : 0.74–0.84, p < 0.0001). Overall survival was similar between the compared arms for patients <50 years old (HR: 0.88, 95% CI : 0.71–1.1, p = 0.216), increased in the mechanical valve arm for patients 50–70 years old (HR : 0.76, 95% CI : 0.70–0.83, p < 0.0001), and increased in the bioprosthetic arm for patients >70 years old (HR : 1.35, 95% CI : 1.17–1.57, p < 0.0001). Meta-regression analysis revealed that the survival in the 50–70 years old group was not influenced by the publication year of the individual studies. No statistically significant difference was observed regarding in-hospital mortality, post-operative strokes and post-operative reoperation. All-cause mortality was found decreased in the mechanical group, cardiac mortality was comparable between the two groups, major bleeding rates were increased in the mechanical valve group, and reoperation rates were increased in the bioprosthetic valve group. Conclusions Survival rates seem to not be influenced by the type of prosthesis in patients <50 years old. A survival advantage in favour of mechanical valves is observed in patients 50–70 years old, while in patients >70 years old bioprosthetic valves offer better survival outcomes.

Objectives: The aim of the study is to compare the safety and efficacy of unilateral anterograde cerebral perfusion (UACP) and bilateral anterograde cerebral perfusion (BACP) for acute type A aortic dissection (ATAAD). Methods: A systematic review of the MEDLINE (PubMed), Scopus, and Cochrane Library databases (last search: August 7th, 2021) was performed according to the PRISMA statement. Studies directly comparing UACP versus BACP for ATAAD were included. Random-effects meta-analyses were performed. Results: Eight retrospective cohort studies were identified, incorporating 2416 patients (UACP: 843, BACP: 1573). No statistically significant difference was observed regarding in-hospital mortality (odds ratio [OR]:1.05 [95% Confidence Interval (95% CI):0.70–1.57]), permanent neurological deficit (PND) (OR: 0.94 [95% CI: 0.52–1.70]), transient neurological deficit (TND) (OR: 1.37 [95% CI: 0.98–1.92]), renal failure (OR: 0.96 [95% CI: 0.70–1.32]), and re-exploration for bleeding (OR: 0.77 [95% CI: 0.48–1.22]). Meta-regression analysis revealed that PND and TND were not influenced by differences in rates of total arch repair, Bentall procedure, and concomitant CABG in UACP and BACP groups. Cardiopulmonary bypass time (Standard Mean Difference [SMD]: −0.11 [95% CI: −0.22, 0.44]), Cross clamp time (SMD: −0.04 [95% CI: −0.38, 0.29]), and hypothermic circulatory arrest time (SMD: −0.12 [95% CI: −0.55, 0.30]) were comparable between UACP and BACP. Intensive care unit stay was shorter in BACP arm (SMD:0.16 [95% CI: 0.01, 0.31]); however, length of hospital stay was shorter in UACP arm (SMD: −0.25 [95% CI: −0.45, −0.06]). Conclusions: UACP and BACP had similar results in terms of in-hospital mortality, PND, TND, renal failure, and re-exploration for bleeding rate in patients with ATAAD. ICU stay was shorter in the BACP arm while LOS was shorter in the UACP arm.

Objective Το perform a systematic review with meta‐analysis of published data comparing outcomes between a percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in dialysis‐dependent patients. Methods We searched PubMed, Scopus, and Cochrane databases for studies including dialysis‐dependent patients who underwent either CABG or PCI. This meta‐analysis follows the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. We conducted one‐stage and two‐stage meta‐analysis with Kaplan–Meier‐derived individual patient data for overall survival and meta‐analysis with the random‐effects model for the in‐hospital mortality and repeat revascularization. Results Twelve studies met our eligibility criteria, including 13,651 and 28,493 patients were identified in the CABG and PCI arms, respectively. Patients who underwent CABG had overall improved survival compared with those who underwent PCI at the one‐stage meta‐analysis (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.09–1.16, p < .0001) and the two‐stage meta‐analysis (HR: 1.15, 95% CI: 1.08–1.23, p < .001, I2 = 30.0%). Landmark analysis suggested that PCI offers better survival before the 8.5 months of follow‐up (HR: 0.96, 95% CI: 0.92–0.99, p = .043), while CABG offers an advantage after this timepoint (HR: 1.3, 95% CI: 1.22–1.32, p < .001). CABG was associated with increased odds for in‐hospital mortality (odds ratio [OR]: 1.70, 95% CI: 1.50–1.92, p < .001, I2 = 0.0%) and decreased odds for repeat revascularization (OR: 0.22, 95% CI: 0.14–0.34, p < .001, I2 = 58.08%). Conclusions In dialysis‐dependent patients, CABG was associated with long‐term survival but a higher risk for early mortality. The risk for repeat revascularization was higher with PCI.

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Advances in multimodal management of locally advanced rectal cancer (LARC), consisting of preoperative chemotherapy and/or radiotherapy followed by surgery with or without adjuvant chemotherapy, have improved local disease control and patient survival but are associated with significant risk for acute and long-term morbidity. Recently published trials, evaluating treatment dose intensification via the addition of preoperative induction or consolidation chemotherapy (total neoadjuvant therapy [TNT]), have demonstrated improved tumor response rates while maintaining acceptable toxicity. In addition, TNT has led to an increased number of patients achieving a clinical complete response and thus eligible to pursue a nonoperative, organ-preserving, watch and wait approach, thereby avoiding toxicities associated with surgery, such as bowel dysfunction and stoma-related complications. Ongoing trials using immune checkpoint inhibitors in patients with mismatch repair-deficient tumors suggest that this subgroup of patients with LARC could potentially be treated with immunotherapy alone, sparing them the toxicity associated with preoperative treatment and surgery. However, the majority of rectal cancers are mismatch repair-proficient and less responsive to immune checkpoint inhibitors and require multimodal management. The synergy noted in preclinical studies between immunotherapy and radiotherapy on immunogenic tumor cell death has led to the design of ongoing clinical trials that explore the benefit of combining radiotherapy, chemotherapy, and immunotherapy (mainly of immune checkpoint inhibitors) and aim to increase the number of patients eligible for organ preservation.