Safety and effectiveness of proximal aortic repair versus total arch replacement for the treatment of acute type A aortic dissection: A systematic review and meta-analysis
- VernacularTitle:近端主动脉修复与全主动脉弓置换术治疗急性A型主动脉夹层安全性和有效性的系统评价与Meta分析
- Author:
Dazhi LI
1
,
2
,
3
;
Xiangwei LI
3
,
4
;
Feng PANG
3
,
4
;
Jinlong LUO
3
,
4
;
Xin DENG
3
,
4
;
Ze ZHANG
3
,
4
;
Xinhong HE
3
,
4
;
Kequan WEI
3
,
4
Author Information
1. 1. Graduate School, Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, P. R. China
2. 2.Department of Cadiothoracic and Vascular Surgery, The People&rsquo
3. s Hospital of Guangxi Zhuang Autonomous Region (Guangxi Academy of Medical Sciences), Nanning, 530021, P. R. China
4. Department of Cadiothoracic and Vascular Surgery, The People&rsquo
- Publication Type:Journal Article
- Keywords:
Acute type A aortic dissection;
proximal aortic repair;
total arch replacement;
complication;
mortality;
systematic review/meta-analysis
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2023;30(04):605-613
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effectiveness and safety of proximal aortic repair (PAR) versus total arch replacement (TAR) for treatment of acute type A aortic dissection (ATAAD). Methods An electronic search was conducted for clinical controlled studies on PAR versus TAR for patients with ATAAD published in Medline via PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Database and CNKI since their inception up to April 30, 2022. The quality of each study included was assessed by 2 evaluators and the necessary data were extracted. STATA 16 software was used to perform statistical analysis of the available data. Results A total of 28 cohort studies involving 7 923 patients with ATAAD were included in this meta-analysis, of whom 5 710 patients received PAR and 2 213 patients underwent TAR, and 96.43% of the studies (27/28) were rated as high quality. The meta-analysis results showed that: (1) patients who underwent PAR had lower incidences of 30 d mortality [RR=0.62, 95%CI (0.50, 0.77), P<0.001], in-hospital mortality [RR=0.64, 95%CI (0.54, 0.77), P<0.001], and neurologic deficiency after surgery [RR=0.84, 95%CI (0.72, 0.98), P=0.032] than those who received TAR; (2) the cardiopulmonary bypass time [WMD=–52.07, 95%CI (–74.19, –29.94), P<0.001], circulatory arrest time [WMD=–10.14, 95%CI (–15.02, –5.26), P<0.001], and operation time [WMD=–101.68, 95%CI (–178.63, –24.73), P<0.001] were significantly shorter in PAR than those in TAR; (3) there was no statistical difference in mortality after discharge, rate of over 5-year survival, renal failure after surgery and re-intervention, volume of red blood cells transfusion and fresh-frozen plasma transfusion, or hospital stay between two surgical procedures. Conclusion Compared with TAR, PAR has a shorter operation time and lower early and in-hospital mortality, but there is no difference in long-term outcomes or complications between the two procedures for patients with ATAAD.
