Baikoussis Nikolaos G, Antonopoulos Constantine N, Papakonstantinou Nikolaos A, Argiriou Mihalis, Geroulakos George
Cardiovascular and Thoracic Surgery Department, General Hospital of Athens "Evangelismos", Athens, Greece.
Cardiovascular and Thoracic Surgery Department, General Hospital of Athens "Evangelismos", Athens, Greece; Department of Vascular Surgery, King's College Hospital, London, United Kingdom.
J Vasc Surg. 2017 Nov;66(5):1587-1601. doi: 10.1016/j.jvs.2017.07.064. Epub 2017 Aug 19.
Conventional open surgery encompassing cardiopulmonary bypass has been traditionally used for the treatment of ascending aorta diseases. However, more than one in five of these patients will be finally considered unfit for open repair. We conducted a systematic review and meta-analysis to investigate the role of thoracic endovascular aortic repair (TEVAR) for aortic diseases limited to the ascending aorta.
The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We investigated patients' baseline characteristics along with early (30 days/in-hospital stay) and late (beyond 30 days/in-hospital stay) outcomes after TEVAR limited to the ascending aorta and not involving the arch vessels. Separate analyses for case reports and case series were conducted, and pooled proportions with 95% confidence intervals (CIs) of outcome rates were calculated.
Approximately 67% of the patients had a prior cardiac operation. TEVAR was performed mainly for acute or chronic Stanford type A dissection (49%) or pseudoaneurysm (28%). The device was usually delivered through the femoral artery (67%), and rapid ventricular pacing was used in nearly half of the patients. Technical success of the method was 95.5% (95% CI, 87.8-99.8). Among the early outcomes, conversion to open repair was 0.7% (95% CI, 0.1-4.8), whereas mortality was 2.9% (95% CI, 0.02-8.6). We estimated a pooled rate of 1.8% (95% CI, 0.1-7.0) for neurologic events (stroke or transient ischemic attack) and 0.8% (95% CI, 0.1-5.6) for myocardial infarction. Late endoleak was recorded in 16.4% (95% CI, 8.2-26.0), and 4.4% (95% CI, 0.1-12.4) of the population died in the postoperative period. Finally, reoperation was recorded in 8.9% (95% CI, 3.1-16.4) of the study sample.
TEVAR in the ascending aorta seems to be safe and feasible for selected patients with various aortic diseases, although larger studies are required.
传统上，包含体外循环的常规开放手术一直用于治疗升主动脉疾病。然而，这些患者中超过五分之一最终会被认为不适合进行开放修复。我们进行了一项系统评价和荟萃分析，以研究胸主动脉腔内修复术（TEVAR）在仅限于升主动脉的主动脉疾病治疗中的作用。
本次荟萃分析采用系统评价和荟萃分析的首选报告项目指南进行。我们调查了患者的基线特征以及仅限于升主动脉且不涉及弓部血管的TEVAR术后的早期（30天/住院期间）和晚期（超过30天/住院期间）结局。对病例报告和病例系列进行了单独分析，并计算了结局率的合并比例及95%置信区间（CI）。
约67%的患者曾接受过心脏手术。TEVAR主要用于急性或慢性A型主动脉夹层（49%）或假性动脉瘤（28%）。器械通常通过股动脉置入（67%），近一半的患者使用了快速心室起搏。该方法的技术成功率为95.5%（95%CI，87.8 - 99.8）。在早期结局中，转为开放修复的比例为0.7%（95%CI，0.1 - 4.8），而死亡率为2.9%（95%CI，0.02 - 8.6）。我们估计神经事件（中风或短暂性脑缺血发作）的合并发生率为1.8%（95%CI，0.1 - 7.0），心肌梗死的发生率为0.8%（95%CI，0.1 - 5.6）。晚期内漏发生率为16.4%（95%CI，8.2 - 26.0），4.4%（95%CI，0.1 - 12.4）的患者在术后死亡。最后，研究样本中有8.9%（95%CI，3.1 - 16.4）的患者进行了再次手术。
对于选定的患有各种主动脉疾病的患者，升主动脉TEVAR似乎是安全可行的，尽管还需要更大规模的研究。
