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

Chumpon Wilasrusmee, Jakrapan Jirasiritham, Napaphat Poprom, Ammarin Thakkinstian. Faculty of Medicine Ramathibodi Hospital, Mahidol University

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.

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, 7 studies (4 randomized controlled trials (RCT) and 3 cohorts) comprising 1,343 patients were eligible for pooling.  Six 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 3 cohorts in this pooling yield similar results with the pooled RR of  1.31 (95% CI: 1.10, 1.57)(figure 1). The pooled RR of graft patency for BP vs VG was 0.75 (95% CI, 0.54, 1.06), indicating 25% lower graft patency but not significant 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.

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