慢性B型主动脉夹层的开放手术修复：一项系统评价
Open surgical repair for chronic type B aortic dissection: a systematic review.
作者信息
Tian David H, De Silva Ramesh P, Wang Tom, Yan Tristan D
机构信息
1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
出版信息
Ann Cardiothorac Surg. 2014 Jul;3(4):340-50. doi: 10.3978/j.issn.2225-319X.2014.07.10.
BACKGROUND
The treatment of chronic type B aortic dissection (CBAD) remains complicated. Thoracic endovascular aortic repair (TEVAR) has supplanted open surgical repair (OSR) as the preferred surgical treatment for CBAD. Despite TEVAR's superior short-term results, much less is understood about its long-term outcomes. As much of the understanding of OSR originates from historical report, contemporary series, with modern surgical techniques and technologies, may present an alternative to TEVAR. The present systematic review will assess the short- and long-term outcomes of historic and contemporary series of OSR for CBAD.
METHODS
Electronic searches were performed using six databases from their inception to March 2014. Relevant studies with OSRs for chronic type B dissection were identified. Data were extracted by two independent reviewers and analyzed according to predefined clinical endpoints. Studies were sub-classified into the pre-endovascular (historic series) and endovascular era (contemporary series) depending on whether the majority of cases were performed after 1999.
RESULTS
Nineteen studies were identified for inclusion for quantitative analysis. Pooled short-term mortality was 11.1% overall, and 7.5% in the nine contemporary studies. Stroke, spinal cord ischemia, renal dysfunction, and reoperation for bleeding were 5.9%, 4.9%, 8.1%, and 8.1%, respectively, for the contemporary series. Absolute late reintervention was identified in 13.3% of patients overall, and in 11.3% of patients in the contemporary series. Aggregated survival at 1-, 3-, 5-, and 10-years of all patients were 82.1%, 74.1%, 66.3%, and 50.8%, respectively.
CONCLUSIONS
OSR for chronic type B dissection in the contemporary era offers acceptable results. Management approaches should be considered carefully, taking into account both short-term and long-term complications. More research is required to clarify specific indications for OSR and TEVAR in chronic type B dissections.
背景
慢性B型主动脉夹层（CBAD）的治疗仍然复杂。胸主动脉腔内修复术（TEVAR）已取代开放手术修复（OSR），成为CBAD首选的手术治疗方法。尽管TEVAR的短期效果更佳，但其长期预后却鲜为人知。由于对OSR的了解大多源于历史报告，采用现代手术技术和科技的当代系列研究可能为TEVAR提供了另一种选择。本系统评价将评估CBAD的历史和当代系列OSR的短期和长期预后。
方法
利用六个数据库从建库至2014年3月进行电子检索。确定了有关OSR治疗慢性B型夹层的相关研究。由两名独立的审阅者提取数据，并根据预先定义的临床终点进行分析。根据大多数病例是否在1999年以后进行，将研究分为血管腔内修复术前（历史系列）和血管腔内修复术时代（当代系列）。
结果
确定了19项研究纳入定量分析。汇总的短期死亡率总体为11.1%，九项当代研究中为7.5%。当代系列中，卒中、脊髓缺血、肾功能不全和出血再次手术的发生率分别为5.9%、4.9%、8.1%和8.1%。总体上，13.3%的患者出现绝对晚期再次干预，当代系列中这一比例为11.3%。所有患者1年、3年、5年和10年的累计生存率分别为82.1%、74.1%、66.3%和50.8%。
结论
当代慢性B型夹层的OSR提供了可接受的结果。应仔细考虑管理方法，同时兼顾短期和长期并发症。需要更多研究来明确OSR和TEVAR在慢性B型夹层中的具体适应证。
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