Muston Benjamin T, Bilbrough James, Bushati Ymer, Wilson-Smith Ashley R, Misfeld Martin, Yan Tristan
The Collaborative Research Group (CORE), Sydney, Australia.
Faculty of Medicine and Health, The University of New South Wales, Sydney, Australia.
Ann Cardiothorac Surg. 2023 Sep 28;12(5):418-428. doi: 10.21037/acs-2023-scp-20. Epub 2023 Sep 19.
Staged procedures are one strategy found to be beneficial for medium- to high-risk Crawford extent I-III thoraco-abdominal aortic aneurysm (TAAA) repair patients and may be performed through a variety of techniques. This review sought to compare the primary outcomes of spinal cord ischemia (SCI) and long-term mortality between three cohorts grouped by approach: open, endovascular, and hybrid.
In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 919 references were extracted from a search of three online databases (Embase, PubMed, Scopus). Following application of inclusion/exclusion criteria and data extraction, quantitative meta-analysis was undertaken utilizing a random effects model. Kaplan-Meier (KM) curves were digitized and aggregated to graph estimated survival.
A total of 20 studies representing 924 patients were included. SCI was highest in the endovascular group, at 9.8% of weighted means, followed by hybrid, and open groups at 3.2% and 1.4%, respectively. However, 30-day mortality was highest in the open group at 6.0%, followed by the hybrid group at 3.8%, and endovascular at 3.6%. Aggregated long-term survival estimations are shown graphically, extending to 5 years for open and endovascular cohorts, and 3 years for the smaller hybrid cohort.
While all cases incorporated spinal drainage, monitoring and staging for spinal protection, there is innate difference in approach when examining for cord ischemia. This systematic review and meta-analysis of staged TAAA repair describes the first comparison between cohorts of open and endovascular approach, revealing the increased risk of SCI and long-term mortality in endovascular repair.
分期手术是一种被发现对中高危Crawford I-III型胸腹主动脉瘤（TAAA）修复患者有益的策略，可通过多种技术进行。本综述旨在比较按手术方式分组的三个队列（开放手术、血管腔内修复术和杂交手术）之间脊髓缺血（SCI）的主要结局和长期死亡率。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，通过检索三个在线数据库（Embase、PubMed、Scopus）共提取了919篇参考文献。在应用纳入/排除标准和数据提取后，采用随机效应模型进行定量Meta分析。对Kaplan-Meier（KM）曲线进行数字化处理并汇总，以绘制估计生存率。
共纳入20项研究，涉及924例患者。血管腔内修复术组的SCI发生率最高，加权均值为9.8%，其次是杂交手术组和开放手术组，分别为3.2%和1.4%。然而，开放手术组的30天死亡率最高，为6.0%，其次是杂交手术组，为3.8%，血管腔内修复术组为3.6%。汇总的长期生存估计以图形显示，开放手术组和血管腔内修复术组延长至5年，较小的杂交手术组延长至3年。
虽然所有病例都采用了脊髓引流、监测和分期以保护脊髓，但在检查脊髓缺血时，手术方式存在固有差异。这项对分期TAAA修复的系统评价和Meta分析描述了开放手术和血管腔内修复术队列之间的首次比较，揭示了血管腔内修复术中SCI风险和长期死亡率增加的情况。
