Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran -
J Cardiovasc Surg (Torino). 2022 Jun;63(3):265-274. doi: 10.23736/S0021-9509.22.12292-5. Epub 2022 Mar 3.
The treatment of complex aortic lesions involving the ascending, arch, and proximal descending aorta, remains challenging for surgeons despite the evolution of surgical techniques and aortic prostheses over decades. The frozen elephant trunk (FET) approach offers a one-stage repair of this entity of aortic pathologies. The main scope of this systematic review and meta-analysis is to evaluate the clinical outcomes and effectiveness of FET.
In a systematic review, multiple electronic databases including EMBASE, Scopus, and PubMed/MEDLINE were searched from inception to June 2021 to identify relevant studies reporting on outcomes of total arch replacement (TAR) with FET.
Eighty-five studies met inclusion criteria, encompassing 10960 patients. Meta-analysis was conducted using the R-studio (RStudio, Boston, MA, USA) and STATA software (StataCorp LLC, College Station, TX, USA). The pooled in-hospital mortality rate was 7% (95% CI 0.05-0.09; I=76%) and 12% for renal failure (95% CI 0.09-0.15; I=88%), while the rates for paraplegia and cerebrovascular accidents were 3% (95% CI 0.02-0.04; I=0%) and 6% (95% CI 0.05-0.08; I=73%), respectively. Lower heterogeneity was attained after the stratification by the aortic pathologies, except for the renal failure. The distal anastomosis of the stent in zone 2 was significantly correlated with a lower renal failure development compared to zone 3 (odds ratio 0.52; 95% CI 0.33-0.82; P=0.069; I=0%).
Our results indicate that the morbidities and mortality following TAR with FET were acceptable. We also associated the distal anastomosis in zone 2 with fewer renal failure development compared to that in zone 3.
尽管数十年来外科技术和主动脉假体不断发展，涉及升主动脉、弓部和近端降主动脉的复杂主动脉病变的治疗仍然对外科医生具有挑战性。冷冻象鼻（FET）方法为这种主动脉病变实体提供了一期修复。本系统评价和荟萃分析的主要目的是评估 FET 的临床结果和效果。
在系统评价中，从创建到 2021 年 6 月，我们在多个电子数据库（包括 EMBASE、Scopus 和 PubMed/MEDLINE）中搜索了报告 FET 行全主动脉弓置换（TAR）的结果的相关研究。
85 项研究符合纳入标准，共纳入 10960 例患者。使用 R-studio（波士顿，MA，美国）和 STATA 软件（德克萨斯州立大学科林斯顿分校，德克萨斯州，美国）进行荟萃分析。汇总的住院死亡率为 7%（95% CI 0.05-0.09；I=76%）和肾衰竭 12%（95% CI 0.09-0.15；I=88%），而截瘫和脑血管意外的发生率分别为 3%（95% CI 0.02-0.04；I=0%）和 6%（95% CI 0.05-0.08；I=73%）。除了肾衰竭之外，通过主动脉病变分层后，异质性降低。与区 3 相比，区 2 中的支架远端吻合与较低的肾衰竭发展显著相关（优势比 0.52；95% CI 0.33-0.82；P=0.069；I=0%）。
我们的结果表明，TAR 联合 FET 后的发病率和死亡率是可以接受的。我们还发现，与区 3 相比，区 2 中的支架远端吻合与较少的肾衰竭发生相关。
