Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University, No. 30, Gaotanyan Road, Shapingba District, Chongqing, 400038, P.R. China.
J Cardiothorac Surg. 2024 Mar 12;19(1):116. doi: 10.1186/s13019-024-02603-3.
The aim of the present systematic review was to determine whether prophylactic use of cerebrospinal fluid drainage (CSFD) contributes to a lower rate of spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD).
PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched to identify all relevant studies reported before May 7, 2023. A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO registration no. CRD42023441392). The primary outcome was permanent SCI. Secondary outcomes were temporary SCI and 30-day/in-hospital mortality. The data were presented as the pooled event rates (ERs) and 95% confidence intervals (CIs).
A total of 1008 studies were screened, of which 34 studies with 2749 patients were included in the present analysis. The mean Downs and Black quality assessment score was 8.71 (range, 5-12). The pooled rate of permanent SCI with prophylactic CSFD was identical to that without prophylactic CSFD (2.0%; 95% CI, 1.0-3.0; P = 0.445). No statistically significant difference was found between the rates of permanent SCI with routine vs. selective prophylactic CSFD (P = 0.596). The pooled rate of temporary SCI was 1.0% (95% CI, 0.00-1.0%). The pooled rate for 30-day or in-hospital mortality was not significantly different (P = 0.525) in patients with prophylactic CSFD (4.0, 95% CI 2.0-6.0) or without prophylactic CSFD (5.0, 95% CI 2.0-7.0).
The systematic review has shown that prophylactic CSFD was not associated with a lower rate of permanent SCI and 30-day or in-hospital mortality after TEVAR for TBAD.
本系统评价的目的是确定在胸主动脉腔内修复术（TEVAR）治疗 B 型主动脉夹层（TBAD）后，预防性使用脑脊液引流（CSFD）是否会降低脊髓缺血（SCI）的发生率。
系统检索了 PubMed、Embase、Web of Science 和 Cochrane 图书馆数据库，以确定截至 2023 年 5 月 7 日之前报告的所有相关研究。按照 PRISMA 指南（PROSPERO 注册号：CRD42023441392）进行系统评价。主要结局为永久性 SCI。次要结局为暂时性 SCI 和 30 天/住院死亡率。数据以汇总事件发生率（ER）和 95%置信区间（CI）表示。
共筛选出 1008 项研究，其中 34 项研究共纳入 2749 例患者纳入本分析。平均 Downs 和 Black 质量评估得分为 8.71（范围：5-12）。预防性使用 CSFD 的永久性 SCI 发生率与未预防性使用 CSFD 的发生率相同（2.0%；95%CI：1.0-3.0；P=0.445）。常规与选择性预防性 CSFD 的永久性 SCI 发生率无统计学差异（P=0.596）。30 天或住院死亡率的汇总率在使用预防性 CSFD（4.0，95%CI：2.0-6.0）或未使用预防性 CSFD（5.0，95%CI：2.0-7.0）的患者中无显著差异（P=0.525）。
系统评价表明，在 TEVAR 治疗 TBAD 后，预防性使用 CSFD 与永久性 SCI 和 30 天或住院死亡率的降低无关。
