Ma Likang, Chai Tianci, Yang Xiaojie, Zhuang Xinghui, Wu Qingsong, Chen Liangwan, Qiu Zhihuang
Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China.
Front Cardiovasc Med. 2022 Sep 27;9:988619. doi: 10.3389/fcvm.2022.988619. eCollection 2022.
Acute type A aortic dissections (ATAAD) pose a challenge to surgeons due to high mortality, and decision making regarding the appropriate procedure is controversial. This study compared the outcomes of hemiarch and total arch replacement for ATAAD.
The PubMed, Web of Science, Embase and Cochrane databases were searched for comparative studies on hemiarch versus total arch replacement that were published before May 1, 2022.
We included 23 observational studies with a total of 4,576 patients. Combined data analysis showed that early mortality (RR = 0.82; 95% CI: 0.70-0.97; = 0.02), incidence of postoperative permanent neurological dysfunction (RR = 0.72; 95%CI:0.54∼0.94; = 0.02), and incidence of renal failure and dialysis (RR = 0.82; 95%CI:0.71∼0.96; = 0.01) were all lower for hemiarch than for total arch replacement. However, hemiarch replacement had a higher rate of late mortality (RR = 1.37; 95%CI:1.10∼1.71; = 0.005). There were no statistically significant differences between the two groups in terms of re-operation for bleeding, aortic re-operation, or postoperative pneumonia.
In this study, hemiarch replacement had better early outcomes but a higher late mortality rate than total arch replacement. Decisions regarding the extent of arch repair should be made according to location and extent of ATAAD and the experience of surgeons to ensure the most favorable prognosis.
[INPLASY.COM], identifier [INPLASY202250088].
急性A型主动脉夹层（ATAAD）因死亡率高而给外科医生带来挑战，关于合适手术方式的决策存在争议。本研究比较了ATAAD半弓置换术和全弓置换术的疗效。
检索PubMed、Web of Science、Embase和Cochrane数据库，查找2022年5月1日前发表的关于半弓置换术与全弓置换术的比较研究。
我们纳入了23项观察性研究，共4576例患者。合并数据分析显示，半弓置换术的早期死亡率（RR = 0.82；95%CI：0.70 - 0.97；P = 0.02）、术后永久性神经功能障碍发生率（RR = 0.72；95%CI：0.54 - 0.94；P = 0.02）以及肾衰竭和透析发生率（RR = 0.82；95%CI：0.71 - 0.96；P = 0.01）均低于全弓置换术。然而，半弓置换术的晚期死亡率较高（RR = 1.37；95%CI：1.10 - 1.71；P = 0.005）。两组在出血再次手术、主动脉再次手术或术后肺炎方面无统计学显著差异。
在本研究中，半弓置换术的早期疗效较好，但晚期死亡率高于全弓置换术。应根据ATAAD的部位和范围以及外科医生的经验来决定弓部修复的范围，以确保最有利的预后。
[INPLASY.COM]，标识符[INPLASY202250088]。
