Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany.
J Vasc Surg. 2011 Oct;54(4):1182-1186.e2. doi: 10.1016/j.jvs.2011.02.069. Epub 2011 Aug 31.
To compare the outcomes of total aortic arch transposition (TAAT) vs hemi-aortic arch transposition (HAAT) for hybrid aortic arch repair.
A systematic search was performed using PubMed between November 1998 and May 2010 by two independent observers. Studies included reporting on patients treated by TAAT or HAAT and stent grafting in a proximal landing zone 0 or 1 by Ishimaru, respectively. Further articles were identified by following MEDLINE links, by cross-referencing from the reference lists, and by following citations for these studies. Case reports and case series of less than five patients were excluded. Primary technical and initial clinical success, perioperative, and late morbidity and mortality were extracted per study and were meta-analyzed.
Fourteen studies were included in the statistical analysis. The number of reported patients totaled 130 for TAAT/zone 0 and 131 for HAAT/zone 1. The primary technical success rate was significantly higher in zone 0 than 1 (95% vs 83%; odds ratio [OR], 4.0; 95% confidence interval [CI], 1.47-10.88; P = .0069), due to significantly higher primary type I or III endoleak rates in zone 1 (15.48% vs 3.97%; P = .0050). Reintervention rates were significantly higher in zone 1 (25.81% vs 12.00%; P = .0321). Initial clinical success rates were comparable between zone 0 and 1 (88% vs 85%; OR, 1.35; 95% CI, 0.61-3.02; P = .5354). In-hospital mortality was higher in zone 0 than 1 (8.46% vs 4.58%; P = .2212).
The more invasive TAAT allows a better landing zone at the cost of higher perioperative mortality, therefore, patient selection is crucial.
比较全主动脉弓置换术（TAAT）与半主动脉弓置换术（HAAT）在杂交主动脉弓修复中的结果。
两名独立观察者于 1998 年 11 月至 2010 年 5 月期间在 PubMed 上进行了系统检索。研究包括分别接受 Ishimaru 报道的近端着陆区 0 或 1 处支架移植治疗的 TAAT 或 HAAT 治疗的患者报告，并通过 MEDLINE 链接、交叉引用参考文献列表和这些研究的引文进一步确定了其他文章。排除少于 5 例的病例报告和病例系列。每篇研究均提取并分析了围手术期和晚期的主要技术和初始临床成功率、发病率和死亡率。
共有 14 项研究纳入统计分析。报道的患者总数为 TAAT/区 0 为 130 例，HAAT/区 1 为 131 例。区 0 的主要技术成功率明显高于区 1（95%对 83%；比值比[OR]，4.0；95%置信区间[CI]，1.47-10.88；P=.0069），主要是因为区 1 的原发性 I 型或 III 型内漏发生率明显较高（15.48%对 3.97%；P=.0050）。区 1 的再干预率明显较高（25.81%对 12.00%；P=.0321）。区 0 和区 1 的初始临床成功率相似（88%对 85%；OR，1.35；95%CI，0.61-3.02；P=.5354）。区 0 的院内死亡率高于区 1（8.46%对 4.58%；P=.2212）。
侵袭性更强的 TAAT 可以在成本更高的围手术期死亡率的情况下获得更好的着陆区，因此，患者选择至关重要。
