Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
J Vasc Surg. 2019 Feb;69(2):598-613.e7. doi: 10.1016/j.jvs.2018.08.154.
One of the factors contributing to complications related to open repair of the aorta is the construction of a hand-sewn anastomosis. Aortic anastomotic devices (AADs), such as the intraluminal ringed graft (IRG), and the anastomotic stenting technique have been developed to perform a sutureless and less complicated anastomosis. This study performed a systematic review and meta-analysis of the literature reporting clinical use of AADs and aimed to assess, primarily, the effect of each device on 30-day overall and operation-related mortality and aortic cross-clamping time and, secondarily, the rate of successful two-sided application of the IRG device and the operation-related morbidity for each device.
An electronic search was performed using MEDLINE, Scopus, ScienceDirect, and Cochrane Library by two independent authors. Our exclusion criteria included studies incorporating fewer than three patients and studies reporting results solely from animals or in vitro testing, results solely from end-to-side anastomosis, and results solely from endarterectomy procedures. The last search date was February 1, 2018.
A total of 41 studies were identified that reported outcomes for the use of three different device types: IRG, anastomotic stenting technique, and surgical staplers. The last two types were classified together as the non-IRG group. The meta-analysis included 27 studies with 50 cohorts incorporating 1260 patients. The median age of the incorporated patients was 61.4 years (range, 51-73 years), and 68.9% were male. The operations were performed for the treatment of acute aortic dissection in 82.3%. The pooled overall 30-day mortality rate varied by device type; IRG devices had a mean rate of all-cause mortality of 9.71%, whereas non-IRG devices were associated with a significantly (I = 15.78%; P for Cochrane Q test < .19) lower rate of death (1.47%). The pooled mean aortic cross-clamping time was 35.83 minutes. Metaregression showed that the performance of two-sided anastomosis with the IRG device significantly decreased the aortic cross-clamping time. However, a successful two-sided ringed anastomosis was performed in approximately half of the cases.
Taking into account that the majority of operations were performed for the treatment of acute aortic dissection, AADs had a relatively low rate of 30-day mortality. Despite the observed heterogeneity in study protocols and the small sample size in the non-IRG group, the non-IRG group presented with the lowest 30-day mortality rate. Specific device-related complications between the different device types need further investigation.
导致主动脉开放修复相关并发症的因素之一是手缝线吻合。为了进行无缝线和更简单的吻合，已经开发出了主动脉吻合装置（AAD），例如腔内环型移植物（IRG）和吻合支架技术。本研究对报告 AAD 临床应用的文献进行了系统评价和荟萃分析，主要目的是评估每种装置对 30 天总体和手术相关死亡率以及主动脉阻断时间的影响，其次是评估 IRG 装置双侧应用的成功率以及每种装置的手术相关发病率。
两位作者通过 MEDLINE、Scopus、ScienceDirect 和 Cochrane Library 进行了电子检索。我们的排除标准包括纳入的研究少于 3 例，以及仅报告动物或体外试验结果、仅报告端侧吻合结果和仅报告内膜切除术结果的研究。最后一次搜索日期是 2018 年 2 月 1 日。
共确定了 41 项研究，这些研究报告了三种不同装置类型的使用结果：IRG、吻合支架技术和外科缝合器。后两种类型被归类为非 IRG 组。荟萃分析包括 27 项研究，共纳入 50 个队列，共 1260 例患者。纳入患者的中位年龄为 61.4 岁（范围为 51-73 岁），68.9%为男性。手术是为治疗急性主动脉夹层进行的，占 82.3%。根据装置类型不同，汇总的 30 天总体死亡率也有所不同；IRG 装置的全因死亡率平均为 9.71%，而非 IRG 装置的死亡率明显（I = 15.78%；P 值<.19）更低（1.47%）。汇总的平均主动脉阻断时间为 35.83 分钟。荟萃回归显示，使用 IRG 装置进行双侧吻合可显著降低主动脉阻断时间。然而，大约一半的病例成功进行了双侧环形吻合。
考虑到大多数手术是为治疗急性主动脉夹层进行的，AAD 的 30 天死亡率相对较低。尽管研究方案存在异质性，并且非 IRG 组的样本量较小，但非 IRG 组的 30 天死亡率最低。不同装置类型之间的特定与装置相关的并发症需要进一步研究。
