Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China.
Vascular Surgery Department, the First Affiliated Hospital of the Medical School of Zhejiang University, Hangzhou, Zhejiang.
Catheter Cardiovasc Interv. 2019 Dec 1;94(7):1018-1025. doi: 10.1002/ccd.28511. Epub 2019 Oct 8.
Endovascular repair has been used in selected ascending aortic dissection patients judged unfit for direct open surgery. However, the selective criteria and the results of endovascular repair of ascending aortic dissection, and the potential risk factors of adverse events were still obscure. The aim of this study was to summarize the published data linking endovascular therapy for ascending aortic dissection.
Studies reporting endovascular repair of ascending aortic dissections were identified by searching PubMed and Embase databases in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, and by reviewing the reference lists of retrieved articles. All available data were pooled and the subgroup analyses were conducted.
A total of nine studies were identified according to the inclusion criteria. The overall technical success was 91.7%. The mean period of follow-up was 34.7 months. The early mortality within 30 days and late mortality during the follow-up were 10.3% and 19.0%, respectively. The incidence of endoleak was 14.3%. In the subgroup analysis, we found that female and oversizing >10% were risk factors of adverse events.
The pooled results suggested that endovascular repair of ascending aortic dissection was feasible, promising, and inspiring. The selection of endovascular therapy should be cautious based on preoperative evaluation. Application of different strategies for different ascending lesions should be considered. The dedicated endograft for ascending aorta is desperately needed before broader application of endovascular repair for ascending aortic pathologies can be achieved.
腔内修复已应用于部分不适合直接开放手术的升主动脉夹层患者。然而，腔内修复升主动脉夹层的选择标准和结果，以及不良事件的潜在危险因素仍不清楚。本研究旨在总结与升主动脉夹层腔内治疗相关的已发表数据。
按照系统评价和荟萃分析的首选报告项目指南，通过搜索 PubMed 和 Embase 数据库，以及检索文章的参考文献列表，确定了报告升主动脉夹层腔内修复的研究。汇总所有可用数据并进行亚组分析。
根据纳入标准，共确定了 9 项研究。总的技术成功率为 91.7%。平均随访时间为 34.7 个月。30 天内的早期死亡率和随访期间的晚期死亡率分别为 10.3%和 19.0%。内漏的发生率为 14.3%。在亚组分析中，我们发现女性和过度扩张率>10%是不良事件的危险因素。
汇总结果表明，腔内修复升主动脉夹层是可行的、有希望的和鼓舞人心的。应根据术前评估谨慎选择腔内治疗。应考虑针对不同升主动脉病变应用不同的策略。在广泛应用腔内修复升主动脉病变之前，迫切需要为升主动脉设计专用的腔内移植物。
