Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom.
Ann Thorac Surg. 2020 Dec;110(6):1941-1949. doi: 10.1016/j.athoracsur.2020.04.069. Epub 2020 Jun 3.
Contemporary outcomes of open repair of thoracoabdominal aortic aneurysms (TAAAs) and descending thoracic aortic aneurysms (DTAs) have not been analyzed in an inclusive meta-analysis.
After a systematic literature search, studies from 2008 to 2018 reporting outcomes of open repair of DTAs or TAAAs were pooled in a single-arm meta-analysis performed using the generic inverse variance method. Primary outcome was operative mortality. Secondary outcomes were late mortality, postoperative stroke, permanent and temporary spinal cord injury, renal failure, respiratory failure, and myocardial infarction.
Fifty-four studies with 12,245 patients were included. Pooled operative mortality for open repair was 10.4% (95% confidence interval [CI], 8.3-12.8): 6.6% (95% CI, 3.7-11.6) for DTA and 10.5% (95% CI, 7.5-14.5) for TAAA. Pooled incidence rate of late mortality was 0.6% (95% CI, 0.5-0.8) per person-year. Pooled rates for postoperative outcomes were 4.9% (95% CI, 3.9-6.1) for stroke; 5.7% (95% CI, 4.3-7.5) and 3.0% (95% CI, 2.1-4.2) for permanent and temporary spinal cord injury, respectively; 13.2% (95% CI, 9.9-17.3) for renal failure; 23.3% (95% CI, 17.5-30.4) for respiratory failure; and 2.7% (95% CI, 1.8-4.1) for myocardial infarction. At metaregression, year of publication, use of the clamp-and-sew technique, and use of the cerebrospinal fluid drain were associated with lower operative mortality. Ruptured aneurysms were associated with higher operative mortality.
Despite improvement, open repair of DTAs and TAAAs continues to be associated with a considerable risk for operative death and perioperative complications. Use of the cerebrospinal fluid drain is associated with better outcomes.
胸主动脉瘤（TAAA）和降主动脉瘤（DTA）的开放修复的当代结果尚未在综合荟萃分析中进行分析。
经过系统的文献检索，对 2008 年至 2018 年期间报告的开放修复 DTA 或 TAAA 结果的研究进行了汇总，采用通用逆方差法进行单臂荟萃分析。主要结局是手术死亡率。次要结局包括晚期死亡率、术后中风、永久性和暂时性脊髓损伤、肾衰竭、呼吸衰竭和心肌梗死。
共纳入 54 项研究，共 12245 例患者。开放修复的汇总手术死亡率为 10.4%（95%置信区间 [CI]，8.3-12.8）：6.6%（95% CI，3.7-11.6）用于 DTA 和 10.5%（95% CI，7.5-14.5）用于 TAAA。汇总的晚期死亡率发生率为 0.6%（95% CI，0.5-0.8）/人年。术后结果的汇总发生率为中风 4.9%（95% CI，3.9-6.1）；永久性和暂时性脊髓损伤分别为 5.7%（95% CI，4.3-7.5）和 3.0%（95% CI，2.1-4.2）；肾衰竭 13.2%（95% CI，9.9-17.3）；呼吸衰竭 23.3%（95% CI，17.5-30.4）；心肌梗死 2.7%（95% CI，1.8-4.1）。在荟萃回归中，发表年份、使用夹闭缝合技术和使用脑脊液引流与较低的手术死亡率相关。破裂的动脉瘤与较高的手术死亡率相关。
尽管有所改善，但 DTA 和 TAAA 的开放修复仍然与手术死亡和围手术期并发症的风险相当大。使用脑脊液引流与更好的结果相关。
