Evidence map›Paper›PMID 39549131›Full record

SynthesisClinical drug investigation2024

A Network Meta-Analysis of Vasodilator Therapies in Pulmonary Hypertension Patients Undergoing Mitral Valve Replacement Surgery: Insights for Optimizing Hemodynamics.

Amr Elrosasy, Ahmed Maher, Abdelraouf Ramadan, Nada G Hamam, Mohamed Soliman, Sara K Kamal, Beshoy Emad Milik, Abdullah Ali Shahat, Menna Nabil Kamel, Ahmed Abdeltawab Ali and 5 more

Abstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Clinical drug investigation, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Amr ElrosasyFaculty of Medicine, Kasr Al-Ainy, Cairo University, Al-Saray Street, El Manial, Cairo, 11562, Egypt. 10912022103193@stud.cu.edu.eg.ORCID http://orcid.org/0000-0002-5592-3908
Ahmed MaherFaculty of Medicine, Al-Azhar University, New-Damietta, Egypt.
Abdelraouf RamadanFaculty of Medicine, Kasr Al-Ainy, Cairo University, Al-Saray Street, El Manial, Cairo, 11562, Egypt.
Nada G HamamFaculty of Medicine, Kasr Al-Ainy, Cairo University, Al-Saray Street, El Manial, Cairo, 11562, Egypt.
Mohamed SolimanFaculty of Medicine, Kasr Al-Ainy, Cairo University, Al-Saray Street, El Manial, Cairo, 11562, Egypt.
Sara K KamalFaculty of Medicine, Kasr Al-Ainy, Cairo University, Al-Saray Street, El Manial, Cairo, 11562, Egypt.
Beshoy Emad MilikFaculty of Medicine, Kasr Al-Ainy, Cairo University, Al-Saray Street, El Manial, Cairo, 11562, Egypt.
Abdullah Ali ShahatFaculty of Medicine, Kasr Al-Ainy, Cairo University, Al-Saray Street, El Manial, Cairo, 11562, Egypt.
Menna Nabil KamelFaculty of Medicine, Kasr Al-Ainy, Cairo University, Al-Saray Street, El Manial, Cairo, 11562, Egypt.
Ahmed Abdeltawab AliFaculty of Medicine, Merit University, Sohag, Egypt.
Loay Abdelnabi HassanFaculty of Medicine, Kasr Al-Ainy, Cairo University, Al-Saray Street, El Manial, Cairo, 11562, Egypt.
Ahmed ZabadyFaculty of Science, Damanhour University, Damanhour, Egypt.
Mohamed Abo ZeidFaculty of Medicine, Tanta University, Tanta, Egypt.ORCID http://orcid.org/0009-0007-8165-9470
Wael AbdelmottalebDepartment of Medicine, New York Medical College/Metropolitan Hospital, New York, NY, USA.
Sameh NassarDepartment of Cardiology, West Virginia University, Morgantown, WV, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivePulmonary hypertension (PH) is a progressive hemodynamic condition associated with significant morbidity and mortality, especially in patients undergoing cardiac surgery. Therefore, the objective of this network meta-analysis (NMA) is to compare the efficacy of various pulmonary vasodilators in perioperative control of PH among patients undergoing mitral valve replacement surgery (MVRS), aiming to address the existing knowledge gap and improve perioperative outcomes.

methodsElectronic databases including PubMed, Cochrane Central Registry of Controlled Trials, Scopus, Embase, and Web of Science (WOS) from inception to 17 September 2024. Only randomized controlled trials (RCTs) evaluating vasodilators in PH patients undergoing MVRS were included. We used netmeta package in RStudio to analyze the outcome data with their corresponding mean difference (MD) and confidence intervals (CI).

resultsSeventeen RCTs including 862 patients were analyzed. Prostacyclin, nitric oxide (NO), and sodium nitroprusside (SN) significantly reduced mean pulmonary arterial pressure with effect sizes [MD, 95% confidence interval (CI)] of (11.77, - 18.78; - 4.76; - 8.3, - 15.9; - 0.6; - 11.02, - 20.1; - 3.8, respectively). While no treatment showed significant efficacy on pulmonary capillary wedge pressure, systolic pulmonary arterial pressure, or heart rate, nitroglycerin, NO, and prostacyclin, showed significant increases in cardiac index with effect sizes (MD, 95% CI) of (1, 0.3; 1.7; 1.2 0.8; 1.6; 1.2 0.8; 1.6, respectively). Additionally, NO, prostacyclin, SN, and nitroglycerin demonstrated significant reductions in systemic vascular resistance (SVR), with effect sizes of. (- 0.54, - 0.82; - 0.26, - 0.37, - 0.65; - 0.09; - 0.47, - 0.77; - 0.16; - 0.14, - 0.24; - 0.03, respectively).

conclusionsThis NMA highlights prostacyclin, nitroglycerin, NO, and SN as consistently effective in improving hemodynamics for patients with PH undergoing MVRS, and provides valuable insights for surgeons to choose the suitable vasodilator for these surgeries. However, limitations and the need for further RCTs are acknowledged.

Indexed as

Heart Valve Prosthesis ImplantationHemodynamicsHypertension, PulmonaryVasodilator AgentsHumansMitral ValveNitric OxideRandomized Controlled Trials as TopicNitric OxideVasodilator Agents

Identifiers

PMID39549131
PMCPMC11638279

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.