Chandra Vishnu M, Norton Elizabeth L, Khaja Minhaj S, Herrera Daniel Giraldo, Williams David M, Yang Bo
Division of Vascular and Interventional Radiology, Department of Radiology & Medical Imaging, University of Virginia Health, Charlottesville, Va.
Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, Ga.
JTCVS Open. 2022 Aug 8;12:37-50. doi: 10.1016/j.xjon.2022.07.012. eCollection 2022 Dec.
Mesenteric malperfusion is a feared complication of aortic dissection, with high mortality. The purpose of this study was to systematically review in-hospital mortality (IHM) of endovascular and surgical management of acute and chronic Stanford type B aortic dissections (TBAD) complicated by mesenteric malperfusion (MesMP).
A systematic search of English language articles was conducted in relevant databases. Data on patient demographics, procedure details, and survival outcomes were collected. Reports were classified by type of intervention performed. Studies that failed to report patient-level outcomes based on specific intervention performed or IHM were excluded. Retrospective chart review of previously published data from a single institution was also performed to further identify cases of TBAD that were managed endovascularly. The Fisher exact test was performed to determine statistical significance.
In total, 37 articles were suitable for inclusion in this systematic review, which yielded 149 patients with a median age 55.0 years (interquartile range, 46.5-65 years) and 79% being male. Overall, in-hospital mortality was 12.8% (19/149) and was similar between endovascular and open surgical interventions (13% vs 11%, = .99). Among endovascular strategies, IHM was greater, although not statistically significant in the thoracic endovascular aortic repair group compared with the fenestration/stenting without thoracic endovascular aortic repair group (24% vs 11%, = .15).
Multiple strategies exist for the management of TBAD with MesMP; however, a majority of cases were managed endovascularly. Despite advances in therapies, mortality remains high at 13%.
肠系膜灌注不良是主动脉夹层可怕的并发症，死亡率很高。本研究的目的是系统回顾急性和慢性B型主动脉夹层（TBAD）合并肠系膜灌注不良（MesMP）的血管内治疗和手术治疗的院内死亡率（IHM）。
在相关数据库中对英文文章进行系统检索。收集患者人口统计学数据、手术细节和生存结果。报告按所进行的干预类型分类。未根据具体干预措施或IHM报告患者水平结果的研究被排除。还对来自单一机构的先前发表数据进行回顾性图表审查，以进一步确定接受血管内治疗的TBAD病例。采用Fisher精确检验确定统计学意义。
总共有37篇文章适合纳入本系统评价，共纳入149例患者，中位年龄55.0岁（四分位间距，46.5 - 65岁），男性占79%。总体而言，院内死亡率为12.8%（19/149），血管内治疗和开放手术干预的死亡率相似（13%对11%，P = 0.99）。在血管内治疗策略中，胸主动脉腔内修复组的IHM更高，尽管与无胸主动脉腔内修复的开窗/支架置入组相比差异无统计学意义（24%对11%，P = 0.15）。
TBAD合并MesMP有多种治疗策略；然而，大多数病例采用血管内治疗。尽管治疗取得了进展，但死亡率仍高达13%。
