急性 A 型主动脉夹层中的全弓与半弓修复术:比较研究的系统回顾和元分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
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引用次数: 0

摘要

背景我们旨在比较全弓置换术(TAR)与半弓置换术(HAR)在治疗急性A型主动脉夹层中的短期和长期疗效。结果共发现 6526 例患者,其中 2060 例(32%)接受了 TAR。37%的患者为女性,平均年龄(标准差)为 59.8 ± 11.8 岁。TAR患者术前灌注不良的发生率更高(34% 对 26%)。TAR组患者的30天死亡率(4404例患者;比值比[OR]1.79,95%置信区间[CI]1.29-2.49)、需要透析的肾衰竭(3475例患者;比值比1.34,95%置信区间[CI]1.02-1.76)和中风发生率呈上升趋势(3292例患者;比值比1.49,95%置信区间[CI]0.93-2.39)。在永久性脊髓损伤、内脏缺血或因出血再次手术的发生率方面没有观察到明显差异。TAR 组的长期死亡率(4408 例患者;HR 1.25,95% CI 0.99-1.57)增加无统计学意义,但主动脉长期再手术率有改善趋势(1359 例患者;HR 0.53;95% CI 0.18-1.59)。在亚组分析中,只有在研究组间灌注不良率差异为 10%的亚组中,长期死亡率的危险比更倾向于 TAR。我们建议采用量身定制的手术方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Total Arch vs Hemiarch Repair in Acute Type A Aortic Dissection: Systematic Review and Meta-Analysis of Comparative Studies

Total Arch vs Hemiarch Repair in Acute Type A Aortic Dissection: Systematic Review and Meta-Analysis of Comparative Studies

Background

We aimed to compare the short- and long-term outcomes of total arch replacement (TAR) vs hemiarch replacement (HAR) in the management of acute type A aortic dissection.

Methods

We searched the literature for studies directly comparing TAR to HAR in acute type A aortic dissection. Hazard ratios (HRs) were extracted from digitized Kaplan-Meier curves.

Results

A total of 6526 patients were identified, of which 2060 (32%) had received a TAR. A total of 37% of patients were female, and the mean age (standard deviation) of the cohort was 59.8 ± 11.8 years. TAR patients had a higher prevalence of preoperative malperfusion (34% vs 26%). The TAR group had higher odds of 30-day mortality (4404 patients; odds ratio [OR] 1.79, 95% confidence interval [CI] 1.29-2.49), renal failure requiring dialysis (3475 patients; OR 1.34, 95% CI 1.02-1.76), and a trend toward higher rates of stroke (3292 patients; OR 1.49, 95% CI 0.93-2.39). No significant differences were observed in prevalence of permanent spinal cord injury, visceral ischemia, or reoperation for bleeding. The TAR group had a non–statistically significant increase in long-term mortality (4408 patients; HR 1.25, 95% CI 0.99-1.57), but showed a trend toward improved freedom from long-term aortic reoperation (1359 patients; HR 0.53; 95% CI 0.18-1.59). In a subgroup analysis, the hazard ratio of long-term mortality favoured TAR in only the subgroup of studies in which the difference in malperfusion was > 10% between groups.

Conclusions

TAR could be associated with improved freedom from long-term aortic reoperation but with potentially increased perioperative risks. We recommend a tailored surgical approach.

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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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