Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
Eur J Vasc Endovasc Surg. 2021 Mar;61(3):396-406. doi: 10.1016/j.ejvs.2020.11.033. Epub 2021 Jan 6.
For thoraco-abdominal aortic aneurysms (TAAA), it is unclear whether it is better to perform hybrid repair in one (single) or two stages (staged). This study aimed to compare the clinical outcomes of single vs. staged hybrid repair of TAAA.
The Medline, Embase, and Cochrane Databases (1 January 1994 to 11 May 2020) were searched for studies on hybrid repair of TAAA. Cohort studies and case series reporting outcomes of single and staged hybrid repair of TAAA were eligible for inclusion. The Newcastle-Ottawa scale and an 18 item tool were used to assess the risk of bias. The primary outcome was 30 day mortality, and the secondary outcomes included post-operative complications, overall survival, and other mid term events. A random effects model was used to calculate pooled estimates.
A total of 37 studies was included in the meta-analysis. The quality assessment of the included studies suggested low or moderate risk of bias. The pooled estimates for aneurysm rupture and death during stage interval were 2% (95% CI 0%-4%, I = 0%) and 4% (95% CI 2%-7%, I = 0%), respectively. Single repair was associated with a significantly higher 30 day risk of death when compared with patients who completed staged procedures successfully (OR 2.64, 95% CI 1.36-5.12, I = 0%). Staged repair also had lower incidence of major adverse cardiac events (MACE) (single: 10%, 95% CI 5%-16%; staged: 2%, 95% CI 0%-5%) and intestinal complications (single: 15%, 95% CI 8%-25%; staged: 3%, 95% CI 1%-6%). For mid term outcomes, single and staged repair had comparable 12 month overall survival, aneurysm related mortality, rate of re-intervention, and graft patency.
Two stage hybrid repair may represent a better choice for patients with controlled risk of aneurysm rupture, because it can provide lower 30 day mortality risks, MACE, and intestinal complications, as well as comparable mid term outcomes. Randomised controlled trials are needed to ascertain the effect of repair staging in patients for elective TAAA.
对于胸腹主动脉瘤（TAAA），尚不清楚是单次还是分期进行杂交修复更好。本研究旨在比较 TAAA 单次与分期杂交修复的临床结局。
检索 Medline、Embase 和 Cochrane 数据库（1994 年 1 月 1 日至 2020 年 5 月 11 日）中关于 TAAA 杂交修复的研究。符合纳入标准的研究为报道 TAAA 单次和分期杂交修复结局的队列研究和病例系列研究。使用纽卡斯尔-渥太华量表和 18 项工具评估偏倚风险。主要结局为 30 天死亡率，次要结局包括术后并发症、总生存率和其他中期事件。采用随机效应模型计算汇总估计值。
共有 37 项研究纳入荟萃分析。纳入研究的质量评估提示存在低或中度偏倚风险。分期间隔期间动脉瘤破裂和死亡的汇总估计值分别为 2%（95%CI 0%-4%，I=0%）和 4%（95%CI 2%-7%，I=0%）。与成功完成分期手术的患者相比，单次修复的 30 天死亡风险显著更高（OR 2.64，95%CI 1.36-5.12，I=0%）。分期修复的重大心脏不良事件（MACE）发生率也较低（单次：10%，95%CI 5%-16%；分期：2%，95%CI 0%-5%）和肠道并发症发生率较低（单次：15%，95%CI 8%-25%；分期：3%，95%CI 1%-6%）。对于中期结局，单次和分期修复的 12 个月总生存率、与动脉瘤相关的死亡率、再干预率和移植物通畅率相当。
对于破裂风险可控的患者，两期杂交修复可能是更好的选择，因为它可以提供较低的 30 天死亡率风险、MACE 和肠道并发症，以及相当的中期结局。需要随机对照试验来确定修复分期在择期 TAAA 患者中的效果。
