Lubna Bakr, Tharushi Wijesena, Ravi De Silva, Jason M. Ali
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Ten studies from three countries with a total of 498 patients were included. Proportional analysis of the branch-first technique estimated mortality of (3%, 95% CI [0.02–0.05]), neurological complications of (8%, 95% CI [0.03–0.13]), re-exploration for bleeding of (9%, 95% CI [0.05–0.13]), and renal replacement therapy of (9%, 95% CI [0.05–0.12]). This meta-analysis revealed no significant differences between the branch-first technique and the conventional technique in mortality (5% vs. 15%, OR = 0.32, 95% CI [0.08–1.18], <i>p</i> = 0.09, <i>I</i>2 = 40%), neurological complications (10% vs. 16%, OR = 0.53, 95% CI [0.24–1.21], <i>p</i> = 0.13, <i>I</i>2 = 0%), or renal replacement therapy (12% vs. 14%, OR = 0.72, 95% CI [0.33–1.59], <i>p</i> = 0.41, <i>I</i>2 = 0%). <i>Conclusions</i>. Branch-first technique provides a promising alternative approach in aortic arch surgery with no different surgical risks and potentially reduced operative complexity. Randomised controlled trials are needed to further investigate the safety and advantages of this technique.</p>\n </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2024 1","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/1869656","citationCount":"0","resultStr":"{\"title\":\"Branch-First Technique of Aortic Arch Replacement: A Systematic Review and Meta-Analysis\",\"authors\":\"Lubna Bakr, Tharushi Wijesena, Ravi De Silva, Jason M. Ali\",\"doi\":\"10.1155/2024/1869656\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n <p><i>Objectives</i>. Aortic arch replacement is a major surgical intervention. This meta-analysis aims to combine the international literature on the branch-first technique to describe its outcomes and offer a comparison to the standard techniques. <i>Methods</i>. PubMed and Cochrane were searched for studies on the branch-first technique in aortic arch surgery including those comparing this technique with the conventional ones. Mortality, neurological complications, bleeding, and renal replacement therapy were the major endpoints of interest. Subgroup analysis was performed for both single- and double-armed studies. Odds ratios with 95% confidence interval were used as summary estimates. The random-effects model was used for all outcomes. <i>Results</i>. Ten studies from three countries with a total of 498 patients were included. Proportional analysis of the branch-first technique estimated mortality of (3%, 95% CI [0.02–0.05]), neurological complications of (8%, 95% CI [0.03–0.13]), re-exploration for bleeding of (9%, 95% CI [0.05–0.13]), and renal replacement therapy of (9%, 95% CI [0.05–0.12]). This meta-analysis revealed no significant differences between the branch-first technique and the conventional technique in mortality (5% vs. 15%, OR = 0.32, 95% CI [0.08–1.18], <i>p</i> = 0.09, <i>I</i>2 = 40%), neurological complications (10% vs. 16%, OR = 0.53, 95% CI [0.24–1.21], <i>p</i> = 0.13, <i>I</i>2 = 0%), or renal replacement therapy (12% vs. 14%, OR = 0.72, 95% CI [0.33–1.59], <i>p</i> = 0.41, <i>I</i>2 = 0%). <i>Conclusions</i>. Branch-first technique provides a promising alternative approach in aortic arch surgery with no different surgical risks and potentially reduced operative complexity. Randomised controlled trials are needed to further investigate the safety and advantages of this technique.</p>\\n </div>\",\"PeriodicalId\":15367,\"journal\":{\"name\":\"Journal of Cardiac Surgery\",\"volume\":\"2024 1\",\"pages\":\"\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2024-08-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/1869656\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiac Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1155/2024/1869656\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiac Surgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/2024/1869656","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
目的。主动脉弓置换术是一项重要的外科干预手术。本荟萃分析旨在综合有关分支先行技术的国际文献,描述其结果并与标准技术进行比较。方法。在 PubMed 和 Cochrane 上搜索有关主动脉弓手术中分支先行技术的研究,包括将该技术与传统技术进行比较的研究。死亡率、神经系统并发症、出血和肾脏替代治疗是研究的主要终点。对单臂和双臂研究进行了分组分析。使用带有 95% 置信区间的比值比作为汇总估计值。所有结果均采用随机效应模型。研究结果来自三个国家的十项研究共纳入了 498 名患者。分支先行技术的比例分析估计死亡率为(3%,95% CI [0.02-0.05]),神经系统并发症为(8%,95% CI [0.03-0.13]),因出血而再次手术为(9%,95% CI [0.05-0.13]),肾脏替代治疗为(9%,95% CI [0.05-0.12])。这项荟萃分析显示,分支先行技术与传统技术在死亡率方面没有显著差异(5% vs. 15%,OR = 0.32,95% CI [0.08-1.18],P = 0.09,I2 = 40%)、神经系统并发症(10% vs. 16%,OR = 0.53,95% CI [0.24-1.21],p = 0.13,I2 = 0%)或肾脏替代治疗(12% vs. 14%,OR = 0.72,95% CI [0.33-1.59],p = 0.41,I2 = 0%)方面无显著差异。结论分支先行技术为主动脉弓手术提供了一种很有前景的替代方法,手术风险无差别,并有可能降低手术复杂性。需要进行随机对照试验来进一步研究该技术的安全性和优势。
Branch-First Technique of Aortic Arch Replacement: A Systematic Review and Meta-Analysis
Objectives. Aortic arch replacement is a major surgical intervention. This meta-analysis aims to combine the international literature on the branch-first technique to describe its outcomes and offer a comparison to the standard techniques. Methods. PubMed and Cochrane were searched for studies on the branch-first technique in aortic arch surgery including those comparing this technique with the conventional ones. Mortality, neurological complications, bleeding, and renal replacement therapy were the major endpoints of interest. Subgroup analysis was performed for both single- and double-armed studies. Odds ratios with 95% confidence interval were used as summary estimates. The random-effects model was used for all outcomes. Results. Ten studies from three countries with a total of 498 patients were included. Proportional analysis of the branch-first technique estimated mortality of (3%, 95% CI [0.02–0.05]), neurological complications of (8%, 95% CI [0.03–0.13]), re-exploration for bleeding of (9%, 95% CI [0.05–0.13]), and renal replacement therapy of (9%, 95% CI [0.05–0.12]). This meta-analysis revealed no significant differences between the branch-first technique and the conventional technique in mortality (5% vs. 15%, OR = 0.32, 95% CI [0.08–1.18], p = 0.09, I2 = 40%), neurological complications (10% vs. 16%, OR = 0.53, 95% CI [0.24–1.21], p = 0.13, I2 = 0%), or renal replacement therapy (12% vs. 14%, OR = 0.72, 95% CI [0.33–1.59], p = 0.41, I2 = 0%). Conclusions. Branch-first technique provides a promising alternative approach in aortic arch surgery with no different surgical risks and potentially reduced operative complexity. Randomised controlled trials are needed to further investigate the safety and advantages of this technique.
期刊介绍:
Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide.
With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery.
In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.