Kemp Ursula, Zhu Alison
Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, NSW, Australia.
Interdiscip Cardiovasc Thorac Surg. 2023 Nov 2;37(5). doi: 10.1093/icvts/ivad172.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'Can a "branch-first" approach to aortic arch replacement be safely utilized in Stanford type A acute aortic syndromes?' Altogether 64 papers were found using the reported searches, of which 10represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All papers included in this BET reported acceptable mortality and/or neurological outcomes in comparison to currently published standards for traditional repair. We conclude that while there is a need for larger series, direct comparison and long-term follow-up, the 'branch-first' approach to aortic arch replacement has been safely performed in several centres in the setting of acute aortic syndromes with results demonstrating acceptable mortality, neurological outcomes and mid-term survival.
根据结构化方案撰写了一篇心脏外科的最佳证据主题文章。所探讨的问题是：“‘分支优先’方法用于斯坦福A型急性主动脉综合征的主动脉弓置换术是否安全？”通过报告的检索共找到64篇论文，其中10篇代表了回答该临床问题的最佳证据。现将这些论文的作者、期刊、出版日期和国家、所研究的患者群体、研究类型、相关结局及结果制成表格。与目前发表的传统修复标准相比，本最佳证据主题文章纳入的所有论文均报告了可接受的死亡率和/或神经学结局。我们得出结论，虽然需要更大规模的系列研究、直接比较和长期随访，但在急性主动脉综合征的情况下，“分支优先”主动脉弓置换术已在多个中心安全实施，结果显示死亡率、神经学结局和中期生存率均可接受。
