Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Caracioni, A.
PLSVC And Its Impact on Mortality
- A Meta-Analysis -
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2024. pp. 57
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Yates Ameli
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- Abstract:
- Abstract in English Background Persistent Left Superior Vena Cava (PLSVC) was first reported in current medical history by Dr. J. J. Charles at Queens College in Cork (Ireland)back in 1889. The anatomic anomaly of a PLSVC is frequently asymptomatic when not associated with congenital heart disease (CHD). It occurs with an incidence of 0.3-0.5% up to maximally 2% within the general population. In case of association with CHD, the overall prevalence may increase to up to 3- 12.7%. Embryologically, in the absence of the involution of the left common cardinal vein and the heart-proximal part of the left superior cardinal vein, a persistent PLSVC evolves. There is no consensus on the impact of PLSVC as a risk factor for mortality on post-operative short-, and long-term outcome following cardiac surgical interventions. We performed a systematic literature review and meta-analysis of the impact of persistent left superior vena cava (PLSVC) on the primary endpoint of mortality following cardiac surgery. Methods We established the corresponding PICOTS-criteria and thoroughly searched using Boolean search terms (("Persistent Left Superior Vena Cava" OR PLSVC) AND (Mortality OR Outcome) AND ("Cardiac Surgery")) on PubMed and Google Scholar. Included were only original articles in English with exclusion of abstracts, book chapters, case reports, and reviews. Twenty-nine results on PubMed and 1660 on Google Scholar were obtained. Titles and abstracts were screened, and 36 articles passed the first screening step, while only 12 were included for further in-depth screening. In the final review using the Newcastle- Ottawa-Scale, we evaluate the twelve studies. We retained three high-quality studies. The study by Keizman et al. was subdivided into two sub-studies for our purposes in the PLSVC meta-analysis, as it provided results for early deaths and 5-year survival measurements. Microsoft Excel for Mac (2023 version 16.80) was used for pivot table calculations, fixed- effect pooled effect measure, homogeneity testing with between-study variance (Tau- squared), as well as random-effects pooled effect measure. Results The consistent average impact of PLSVC on mortality across studies was 5.246 (CI 95% 4.544, 5.947) determined through the fixed-effect pooled effect measure. Homogeneity testing resulted in a Q-value of 11.9 (significantly over 3 degrees of freedom), indicative of heterogeneity. However, a p-value of 0.992 indicates that the observed variability in effect sizes is not statistically significant, thus, the differences in effect sizes among the studies are statistically due to random chance rather than systematic differences. The random-effects meta-analysis after adjusting for between-study-variance with tau- squared, supported by a variance of 0.745679809, displays a 5.463 (CI 95% 3.77, 7.155) consistent average impact of PLSVC on mortality across studies. These results indicate that the presence of a PLSVC increases the likelihood of death by 5.5- fold, compared to the absence of a PLSVC. Conclusions An isolated PLSVC, without any additional associated cardiac anomalies, is generally considered a benign condition, however, alters morbidity and mortality when associated with CHDs. Our pooled study population elicited an overall effect measure of 5.463 after between-study-variation adjustment, representing the consistent average impact of PLSVC on mortality across studies. These results indicate that the presence of a PLSVC increases the likelihood of death by 5.5-fold, compared to the absence of a PLSVC.