The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia;
Ann Cardiothorac Surg. 2013 Mar;2(2):148-58. doi: 10.3978/j.issn.2225-319X.2013.03.13.
A recent concern of deep hypothermic circulatory arrest (DHCA) in aortic arch surgery has been its potential association with increased risk of coagulopathy, elevated inflammatory response and end-organ dysfunction. Recently, moderate hypothermic circulatory arrest (MHCA) with selective antegrade circulatory arrest (SACP) seeks to negate potential hypothermia-related morbidities, while maintaining adequate neuroprotection. The present meta-analysis aims to compare postoperative outcomes in arch surgery using DHCA or MHCA+SACP as neuroprotective strategies.
Electronic searches were performed using six databases from their inception to January 2013. Two reviewers independently identified all relevant studies comparing DHCA with MHCA+SACP, as defined by a recent hypothermia temperature consensus. Data were extracted and meta-analyzed according to pre-defined clinical endpoints.
Nine comparative studies were identified for inclusion in the present meta-analysis. Stroke rates were significantly lower in patients undergoing MHCA+SACP (P=0.0007, I(2)=0%), while comparable results were observed with temporary neurological deficit, mortality, renal failure or bleeding. Infrequent and inconsistent reporting of systemic outcomes precluded analysis of other systemic outcomes.
The present meta-analysis indicated the superiority of MHCA+SACP in terms of stroke risk.
深低温停循环（DHCA）在主动脉弓手术中的一个新关注点是其与凝血功能障碍、炎症反应升高和终末器官功能障碍风险增加的潜在关联。最近，采用选择性顺行循环阻断（SACP）的中低温停循环（MHCA）试图消除潜在的低温相关疾病，同时保持足够的神经保护。本荟萃分析旨在比较使用 DHCA 或 MHCA+SACP 作为神经保护策略的弓部手术的术后结果。
从数据库建立到 2013 年 1 月，使用六个数据库进行电子检索。两名审查员独立确定了所有比较 DHCA 与 MHCA+SACP 的相关研究，DHCA 和 MHCA+SACP 的定义是根据最近的低温共识。根据预先定义的临床终点提取和荟萃分析数据。
确定了 9 项比较研究纳入本荟萃分析。接受 MHCA+SACP 的患者卒中发生率明显降低（P=0.0007，I(2)=0%），而暂时性神经功能缺损、死亡率、肾衰竭或出血的结果相似。系统结局的报告频率低且不一致，排除了对其他系统结局的分析。
本荟萃分析表明，MHCA+SACP 在卒中风险方面具有优势。
