复杂型和非复杂型急性 B 型夹层的治疗。系统评价和荟萃分析。
Management of complicated and uncomplicated acute type B dissection. A systematic review and meta-analysis.
机构信息
1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece.
出版信息
Ann Cardiothorac Surg. 2014 May;3(3):234-46. doi: 10.3978/j.issn.2225-319X.2014.05.08.
BACKGROUND
The management of acute type B dissection represents a clinical challenge. We undertook a systematic review of the available literature regarding medical, surgical and endovascular treatments of acute type B aortic dissection and combined the eligible studies into a meta-analysis.
METHODS
An extensive electronic health database search was performed on all articles published from January 2006 up to November 2013 describing the management of acute type B aortic dissection. Studies including less than 15 patients were excluded.
RESULTS
ACUTE COMPLICATED TYPE B DISSECTION: overall, 2,531 patients were treated with endovascular repair (TEVAR) and the pooled rate for 30-day/in-hospital mortality was 7.3%. The pooled estimates for cerebrovascular events, spinal cord ischemia (SCI) and total neurologic events were 3.9%, 3.1% and 7.3%, respectively. A total of 1,276 patients underwent open surgical repair and the pooled rate for 30-day/in-hospital mortality was 19.0%. The pooled rate for cerebrovascular events was 6.8%, for SCI 3.3% and for total neurologic complications 9.8%. Acute uncomplicated type B dissection: outcome of 2,347 patients who underwent conservative medical management were analyzed. The pooled 30-day/in-hospital mortality rate was 2.4%. The pooled rate for cerebrovascular events was 1%, for SCI 0.8% and for overall neurologic complications 2%.
CONCLUSIONS
Endovascular repair provides a superior 30-day/in-hospital survival for acute complicated type B aortic dissection compared to surgical aortic reconstruction. However, open repair still has a significant role as endovascular repair is not applicable in all patients and there remains concerns regarding the durability of this technique. TEVAR seems to have a more favorable outcome regarding aortic remodeling and the aortic-specific survival rate when compared with medical therapy alone. Randomized controlled trials focusing on the prognostic factors of early and late complications in uncomplicated type B dissections are needed.
背景
急性 B 型主动脉夹层的治疗极具挑战性。我们对 2006 年 1 月至 2013 年 11 月期间发表的有关急性 B 型主动脉夹层内科、外科和血管内治疗的所有文献进行了系统回顾，并将符合条件的研究进行了荟萃分析。
方法
对所有描述急性 B 型主动脉夹层治疗的文章进行了广泛的电子健康数据库检索，排除了少于 15 例患者的研究。
结果
急性复杂 B 型夹层：共有 2531 例患者接受了血管内修复（TEVAR）治疗，30 天/住院死亡率的合并率为 7.3%。脑血管事件、脊髓缺血（SCI）和总神经事件的合并发生率分别为 3.9%、3.1%和 7.3%。共 1276 例患者接受了开放手术修复，30 天/住院死亡率的合并率为 19.0%。脑血管事件的合并发生率为 6.8%，SCI 为 3.3%，总神经并发症为 9.8%。急性不复杂 B 型夹层：分析了 2347 例接受保守内科治疗患者的结果。30 天/住院死亡率的合并率为 2.4%。脑血管事件的合并发生率为 1%，SCI 为 0.8%，总神经并发症为 2%。
结论
与主动脉重建术相比，血管内修复术为急性复杂 B 型主动脉夹层提供了更好的 30 天/住院生存率。然而，开放修复仍然具有重要作用，因为血管内修复术并不适用于所有患者，而且人们仍然对该技术的耐久性存在担忧。与单纯药物治疗相比，TEVAR 在主动脉重塑和主动脉特异性生存率方面似乎具有更好的结果。需要进行随机对照试验，重点研究不复杂的 B 型夹层早期和晚期并发症的预后因素。
Zotero 插件