Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
BMJ Open. 2021 Mar 4;11(3):e043323. doi: 10.1136/bmjopen-2020-043323.
To review comparisons of the effectiveness of endovascular stent grafting (ESG) against open surgical repair (OSR) for treatment of chronic arch or descending thoracic aortic aneurysms (TAA).
Systematic review and meta-analysis DATA SOURCES: MEDLINE, EMBASE, CENTRAL, WHO International Clinical Trials Routine data collection, current controlled trials, clinical trials and the NIHR portfolio were searched from January 1994 to March 2020.
All identified studies that compared ESG and OSR, including randomised controlled trials (RCTs), quasi-randomised and non-RCTs, comparative cohort studies and case-control studies matched on main outcomes were sought. Participants had to receive elective treatments for arch/descending (TAA). Studies were excluded where other thoracic aortic conditions (eg, rupture or dissection) were reported, unless results for patients receiving elective treatment for arch/descending TAA reported separately.
Data were extracted by one reviewer and checked by another. Risk of Bias was assessed using the ROBINS-I tool. Meta-analysis was conducted using random effects. Where meta-analysis not appropriate, results were reported narratively.
Five comparative cohort studies met inclusion criteria, reporting 3955 ESG and 21 197 OSR patients. Meta-analysis of unadjusted short-term (30 day) all-cause mortality favoured ESG (OR 0.75; 95% CI 0.55 to 1.03)). Heterogeneity identified between larger and smaller studies. Sensitivity analysis of four studies including only descending TAA showed no statistical significance (OR 0.73, 95% CI 0.45 to 1.18)), moderate heterogeneity. Meta-analysis of adjusted short-term all-cause mortality favoured ESG (OR 0.71, 95% CI 0.51 to 0.98)), no heterogeneity. Longer-term (beyond 30 days) survival from all-cause mortality favoured OSR in larger studies and ESG in smaller studies. Freedom from reintervention in the longer-term favoured OSR. Studies reporting short-term non-fatal complications suggest fewer events following ESG.
There is limited and increasingly dated evidence on the comparison of ESG and OSR for treatment of arch/descending TAA.
CRD42017054565.
综述血管内支架移植物（ESG）与开放手术修复（OSR）治疗慢性主动脉弓或降主动脉瘤（TAA）的效果比较。
系统评价和荟萃分析
1994 年 1 月至 2020 年 3 月，检索 MEDLINE、EMBASE、CENTRAL、WHO 国际临床试验注册平台、当前对照试验、临床试验和英国国家卫生与保健优化研究所投资组合。
所有比较 ESG 和 OSR 的已确定研究，包括随机对照试验（RCT）、准随机和非 RCT、比较队列研究和病例对照研究，均针对主要结局进行匹配。参与者必须接受选择性治疗弓/降（TAA）。如果报告了其他胸主动脉疾病（例如破裂或夹层），除非分别报告了接受弓/降 TAA 选择性治疗的患者的结果，否则将排除这些研究。
由一名评审员提取数据，另一名评审员检查。使用 ROBINS-I 工具评估偏倚风险。使用随机效应进行荟萃分析。如果不适合进行荟萃分析，则以叙述方式报告结果。
5 项符合纳入标准的比较队列研究，共报告了 3955 例 ESG 和 21197 例 OSR 患者。未调整的短期（30 天）全因死亡率荟萃分析有利于 ESG（OR 0.75；95%CI 0.55 至 1.03））。在较大和较小的研究之间存在异质性。包括仅降主动脉 TAA 的四项研究的敏感性分析显示无统计学意义（OR 0.73，95%CI 0.45 至 1.18）），中度异质性。调整后的短期全因死亡率荟萃分析有利于 ESG（OR 0.71，95%CI 0.51 至 0.98）），无异质性。较长时间（30 天以上）全因死亡率生存有利于较大研究中的 OSR 和较小研究中的 ESG。较长时间（30 天以上）的免于再干预有利于 OSR。报告短期非致命性并发症的研究表明 ESG 后事件较少。
目前关于 ESG 和 OSR 治疗弓/降 TAA 的比较证据有限且日益陈旧。
PROSPERO 注册号：CRD42017054565。
