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Clinical results of biologic prosthesis: A systematic review and meta-analysis of comparative studies

View Article: PubMed Central - PubMed

ABSTRACT

Background: Biologic prosthesis (BP) has been reported as a safe alternative to polytetrafluoroethylene (PTFE) in vascular reconstruction. However, efficacy of BP remains controversial. We, therefore, conducted a systematic review to summarize previous available evidences comparing the BP and PTFE in terms of clinical outcomes.

Materials and methods: A literature search of the MEDLINE and Scopus was performed to identify comparative studies reporting outcomes of BP, PTFE, and/or autologous veins graft (VG) in vascular access for hemodialysis or femoropopliteal bypass. The outcome of interest was graft patency. Two reviewers independently extracted data. Meta-analysis with a random-effect model was applied to pool a risk ratio (RR) across studies.

Results: Among 584 articles identified, 11 studies (4 randomized controlled trials (RCT) and 7 cohorts) comprising 2627 patients were eligible for pooling. Seven studies compared BP with PTFE and 3 studies compared PTFE with VG. Among BP vs PTFE, pooling based on 3 RCTs yielded the pooled RR of 1.54 (95% CI: 1.10, 2.16), indicating 54% higher graft patency in VG than PTFE. Adding the 7 cohorts in this pooling yield similar results with the pooled RR of 1.29 (95% CI: 1.15, 1.45). The pooled RR of graft patency for BP vs VG was 0.74 (95% CI, 0.55, 1.00), indicating 26% lower graft patency in BP than VG.

Conclusions: Our first meta-analysis indicated that the biosynthetic prosthesis might be benefit over PTFE by increasing graft patency. An updated meta-analysis or a large scale randomized control trial is required to confirm this benefit.

No MeSH data available.


Meta-analysis of graft patency between BP and PTFE.
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fig2: Meta-analysis of graft patency between BP and PTFE.

Mentions: Comparing biologic prosthesis (BP) VS PTFE, pooling was based on 3 RCTs with a sample size of 187 vs 213. The RR was moderately heterogeneous (Chi-square = 4.64 (d.f. = 2) p = 0.098; I2 = 56.90%), see Fig. 2. Pooling with a random-effect model yielded the pooled RR of 1.54 (95% CI: 1.10, 2.16), indicating 54% higher graft patency in BP than PTFE). A sensitivity analysis was performed by adding the 7 cohorts in this pooling which yield similar results with the pooled RR of 1.29 (95% CI: 1.15, 1.45) (Fig. 3). Neither Egger's test nor the funnel plot suggested asymmetry (coefficient = 1.44, SE = 0.64, p = 0.05).


Clinical results of biologic prosthesis: A systematic review and meta-analysis of comparative studies
Meta-analysis of graft patency between BP and PTFE.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5304244&req=5

fig2: Meta-analysis of graft patency between BP and PTFE.
Mentions: Comparing biologic prosthesis (BP) VS PTFE, pooling was based on 3 RCTs with a sample size of 187 vs 213. The RR was moderately heterogeneous (Chi-square = 4.64 (d.f. = 2) p = 0.098; I2 = 56.90%), see Fig. 2. Pooling with a random-effect model yielded the pooled RR of 1.54 (95% CI: 1.10, 2.16), indicating 54% higher graft patency in BP than PTFE). A sensitivity analysis was performed by adding the 7 cohorts in this pooling which yield similar results with the pooled RR of 1.29 (95% CI: 1.15, 1.45) (Fig. 3). Neither Egger's test nor the funnel plot suggested asymmetry (coefficient = 1.44, SE = 0.64, p = 0.05).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Biologic prosthesis (BP) has been reported as a safe alternative to polytetrafluoroethylene (PTFE) in vascular reconstruction. However, efficacy of BP remains controversial. We, therefore, conducted a systematic review to summarize previous available evidences comparing the BP and PTFE in terms of clinical outcomes.

Materials and methods: A literature search of the MEDLINE and Scopus was performed to identify comparative studies reporting outcomes of BP, PTFE, and/or autologous veins graft (VG) in vascular access for hemodialysis or femoropopliteal bypass. The outcome of interest was graft patency. Two reviewers independently extracted data. Meta-analysis with a random-effect model was applied to pool a risk ratio (RR) across studies.

Results: Among 584 articles identified, 11 studies (4 randomized controlled trials (RCT) and 7 cohorts) comprising 2627 patients were eligible for pooling. Seven studies compared BP with PTFE and 3 studies compared PTFE with VG. Among BP vs PTFE, pooling based on 3 RCTs yielded the pooled RR of 1.54 (95% CI: 1.10, 2.16), indicating 54% higher graft patency in VG than PTFE. Adding the 7 cohorts in this pooling yield similar results with the pooled RR of 1.29 (95% CI: 1.15, 1.45). The pooled RR of graft patency for BP vs VG was 0.74 (95% CI, 0.55, 1.00), indicating 26% lower graft patency in BP than VG.

Conclusions: Our first meta-analysis indicated that the biosynthetic prosthesis might be benefit over PTFE by increasing graft patency. An updated meta-analysis or a large scale randomized control trial is required to confirm this benefit.

No MeSH data available.