Miao Ling, Song Lei, Sun Sheng-Kai, Wang Zhen-Guo
Postgraduate Training Base, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Liaoning Medical University, Tianjin, China.
Department of Heart Center, Affiliated Hospital of Logistics University of the Chinese People's Armed Police Forces, Tianjin, China.
Interact Cardiovasc Thorac Surg. 2017 Jan;24(1):34-40. doi: 10.1093/icvts/ivw305. Epub 2016 Sep 22.
To conduct a meta-analysis of available comparative studies evaluating hybrid arch repair versus open surgical repair of aortic arch aneurysm.
A literature search was performed using PubMed, Embase and Web of Science to identify any studies comparing the results of hybrid arch repair with open surgical repair of aortic arch aneurysm. Study quality was assessed with the Newcastle-Ottawa Scale. Statistical heterogeneity was estimated using the chi-square test. A random-effects model was used to illustrate heterogeneity. Publication bias was evaluated by funnel plots.
Seven retrospective cohort studies from 2009 to 2016 comprising 727 patients were included. Among these patients, 269 were treated with hybrid arch repair and 458 with open surgical repair. There was no significant difference in operative mortality (OR 0.75; 95% CI 0.41-1.39; P = 0.37), permanent neurological deficit (OR 1.24; 95% CI 0.73-2.13; P = 0.42), late mortality (2 years) (OR 3.41; 95% CI 0.83-14.03; P = 0.09) or renal failure (OR 0.80; 95% CI 0.40-1.61; P = 0.53). Interestingly, the meta-analysis indicated that the hybrid group needed more reinterventions (OR 3.43; 95% CI 1.72-6.84; P = 0.0005).
We found no strong evidence indicating that hybrid arch repair is superior to open surgical repair. Furthermore, the hybrid arch repair resulted in more reinterventions despite the fact that it was a less invasive procedure; it also required fewer days in the hospital. Further studies with large numbers of participants and long-term follow-ups are necessary to confirm the effectiveness of hybrid arch repair.
对评估主动脉弓动脉瘤杂交弓修复术与开放手术修复术的现有比较研究进行荟萃分析。
使用PubMed、Embase和Web of Science进行文献检索，以确定任何比较杂交弓修复术与主动脉弓动脉瘤开放手术修复术结果的研究。采用纽卡斯尔-渥太华量表评估研究质量。使用卡方检验估计统计异质性。采用随机效应模型来说明异质性。通过漏斗图评估发表偏倚。
纳入了2009年至2016年的7项回顾性队列研究，共727例患者。其中，269例接受杂交弓修复术，458例接受开放手术修复术。手术死亡率（OR 0.75；95%CI 0.41 - 1.39；P = 0.37）、永久性神经功能缺损（OR 1.24；95%CI 0.73 - 2.13；P = 0.42）、晚期死亡率（2年）（OR 3.41；95%CI 0.83 - 14.03；P = 0.09）或肾衰竭（OR 0.80；95%CI 0.40 - 1.61；P = 0.53）方面无显著差异。有趣的是，荟萃分析表明杂交组需要更多的再次干预（OR 3.43；95%CI 1.72 - 6.84；P = 0.0005）。
我们没有发现有力证据表明杂交弓修复术优于开放手术修复术。此外，尽管杂交弓修复术是一种侵入性较小的手术，但它导致了更多的再次干预；住院天数也较少。需要进行更多参与者和长期随访的进一步研究来证实杂交弓修复术的有效性。
