Thoracic Endovascular Aortic Repair Versus Open Surgery for Stanford Type B Aortic Dissection: A Meta-Analysis and Systematic Review.

IF 0.7 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Surgery Forum Pub Date : 2023-06-29 DOI:10.59958/hsf.5333
Ying Yu, Ji'ao Wang, Bingchen Duan, Pengpeng Wang
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Abstract

Background: Thoracic endovascular aortic repair is a relatively new technique relative to open surgery, and our aim was to assess whether there is a difference in the risk of common postoperative complications between thoracic endovascular aortic repair and open surgery.

Methods: The PubMed, Web of Science, and Cochrane library were systematically searched for trials comparing thoracic endovascular aortic repair and open surgical repair from January 2000 to September 2022. Primary outcome was death, other outcomes included common associated complications. Data were combined using risk ratio or standardized mean difference with 95% confidence interval. Funnel plot and egger's test were used for assessing publication bias. The study protocol was registered prospectively with PROSPERO (CRD42022372324).

Results: This trial included 11 controlled clinical studies with 3667 patients. Thoracic endovascular aortic repair had lower risk of death (risk ratio [RR], 0.59; 95% CI, 0.49 to 0.73; p < 0.00001; I2 = 0), dialysis (RR, 0.55; 95% CI, 0.47 to 0.65; p < 0.00001; I2 = 37%), stroke (RR, 0.71; 95% CI, 0.51 to 0.98; p = 0.03; I2 = 40%), bleeding (RR, 0.44; 95% CI, 0.23 to 0.83; p = 0.01; I2 = 56%), and respiratory complications (RR, 0.67; 95% CI, 0.60 to 0.76; p < 0.00001; I2 = 37%) compared with open surgical repair. In addition, the length of hospital stay was shorter in the thoracic endovascular aortic repair group (SMD, -0.84; 95% CI, -1.30 to -0.38; p = 0.0003; I2 = 80%).

Conclusions: Thoracic endovascular aortic repair has significant advantages over open surgical repair, in terms of postoperative complications and survival in Stanford type B aortic dissection patients.

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Stanford B型主动脉夹层的胸血管内主动脉修复与开放手术:荟萃分析和系统评价。
背景:相对于开放手术,胸腔血管内主动脉修复是一项相对较新的技术,我们的目的是评估胸腔血管内主动脉修复与开放手术在常见术后并发症的风险方面是否存在差异。方法:系统检索PubMed、Web of Science和Cochrane图书馆2000年1月至2022年9月期间比较胸腔血管内主动脉修复和开放性手术修复的试验。主要结局是死亡,其他结局包括常见的相关并发症。数据采用风险比或95%置信区间的标准化平均差进行合并。采用漏斗图和egger检验评估发表偏倚。该研究方案在PROSPERO进行了前瞻性注册(CRD42022372324)。结果:本试验纳入11项对照临床研究,共3667例患者。胸段血管内主动脉修复术的死亡风险较低(风险比[RR], 0.59;95% CI, 0.49 ~ 0.73;P < 0.00001;I2 = 0),透析(RR, 0.55;95% CI, 0.47 ~ 0.65;P < 0.00001;I2 = 37%),卒中(RR, 0.71;95% CI, 0.51 ~ 0.98;P = 0.03;I2 = 40%)、出血(RR, 0.44;95% CI, 0.23 ~ 0.83;P = 0.01;I2 = 56%),呼吸系统并发症(RR, 0.67;95% CI, 0.60 ~ 0.76;P < 0.00001;I2 = 37%)与开放手术修复相比。此外,胸主动脉腔内修复组住院时间更短(SMD, -0.84;95% CI, -1.30 ~ -0.38;P = 0.0003;I2 = 80%)。结论:在Stanford B型主动脉夹层患者的术后并发症和生存率方面,胸腔血管内主动脉修复术明显优于开放手术修复术。
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来源期刊
Heart Surgery Forum
Heart Surgery Forum 医学-外科
CiteScore
1.20
自引率
16.70%
发文量
130
审稿时长
6-12 weeks
期刊介绍: The Heart Surgery Forum® is an international peer-reviewed, open access journal seeking original investigative and clinical work on any subject germane to the science or practice of modern cardiac care. The HSF publishes original scientific reports, collective reviews, case reports, editorials, and letters to the editor. New manuscripts are reviewed by reviewers for originality, content, relevancy and adherence to scientific principles in a double-blind process. The HSF features a streamlined submission and peer review process with an anticipated completion time of 30 to 60 days from the date of receipt of the original manuscript. Authors are encouraged to submit full color images and video that will be included in the web version of the journal at no charge.
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