Sule Jai, Chua Cher Rui, Teo Caven, Choong Andrew, Sazzad Faizus, Kofidis Theo, Sorokin Vitaly
Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Scand Cardiovasc J. 2022 Dec;56(1):91-99. doi: 10.1080/14017431.2022.2074095.
. Composite frozen elephant trunk is an increasingly popular solution for complex aortic pathologies. This review aims to compare outcomes of zone 0 type II hybrid (hybrid II) with the composite frozen elephant trunk (FET) technique in managing acute Stanford type A aortic dissections. . PubMed and Embase were systematically searched using PRISMA protocol. 11 relevant studies describing the outcomes of hybrid II arch repair and FET techniques in patients with type A aortic dissection were included in the meta-analysis. The study focused on early post-operative 30-day outcomes analysing mortality, stroke, spinal cord injury, renal impairment requiring dialysis, bleeding and lung infection. . 1305 patients were included in the analysis - 343 receiving hybrid II repair and 962 treated with the FET. Meta-analysis of proportions showed Hybrid II was associated with less early mortality [5.0 (CI 3.1-7.8) vs 8.1 (CI 6.5-10.0) %], stroke [2.3 (CI 1.1-4.6) vs 7.0 (CI 5.5-8.8) %], spinal cord injury [2.0 (CI 0.9-4.3) vs 3.8 (CI 2.8-5.3) %], renal impairment requiring dialysis [7.9 (CI 5.5-11.2) vs 11.8 (CI 9.8-14.0) %], reoperation for bleeding [3.9 (CI 1.8-8.4) vs 10.6 (CI 8.1-13.8) %] and lung infection [14.8 (CI 10.8-20.0) vs 20.7 (CI 16.9-25.1) %]. . Hybrid II should be considered in favour of FET technique in acute Stanford type A dissection patients who are at higher risk due to age and comorbidities.
复合冰冻象鼻技术是治疗复杂主动脉病变越来越常用的方法。本综述旨在比较0区II型杂交（杂交II）技术与复合冰冻象鼻（FET）技术治疗急性Stanford A型主动脉夹层的疗效。按照PRISMA方案系统检索PubMed和Embase数据库。11项描述杂交II型主动脉弓修复术和FET技术治疗A型主动脉夹层患者疗效的相关研究纳入荟萃分析。该研究聚焦术后30天早期疗效，分析死亡率、卒中、脊髓损伤、需要透析的肾功能损害、出血和肺部感染情况。1305例患者纳入分析，其中343例行杂交II修复术，962例接受FET治疗。比例的荟萃分析显示，杂交II与更低的早期死亡率相关[5.0（95%CI 3.1 - 7.8）%对8.1（95%CI 6.5 - 10.0）%]、卒中[2.3（95%CI 1.1 - 4.6）%对7.0（95%CI 5.5 - 8.8）%]、脊髓损伤[2.0（95%CI 0.9 - 4.3）%对3.8（95%CI 2.8 - 5.3）%]、需要透析的肾功能损害[7.9（95%CI 5.5 - 11.2）%对11.8（95%CI 9.8 - 14.0）%]、因出血再次手术[3.9（95%CI 1.8 - 8.4）%对10.6（95%CI 8.1 - 13.8）%]和肺部感染[14.8（95%CI 10.8 - 20.0）%对20.7（95%CI 16.9 - 25.1）%]。对于因年龄和合并症而风险较高的急性Stanford A型夹层患者，应考虑采用杂交II技术而非FET技术。
