急性 A 型主动脉夹层的中心型与外周型置管：超过 14000 例患者的荟萃分析。
Central versus peripheral cannulation for acute type A aortic dissection: A meta-analysis of over 14,000 patients.
机构信息
Albany Medical College, Albany, NY, USA.
Department of Cardiothoracic Surgery, University of Pittsburgh, Pennsylvania, USA; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, USA.
出版信息
Am J Surg. 2024 Nov;237:115780. doi: 10.1016/j.amjsurg.2024.115780. Epub 2024 May 29.
OBJECTIVE
The optimal cannulation strategy for patients with acute type A aortic dissections (ATAAD) is unclear.
METHODS
A systematic search was performed to identify all studies comparing aortic and non-aortic cannulation in patients undergoing ATAAD repair. The primary endpoint was overall survival. The secondary endpoints were operative mortality, postoperative stroke, renal failure, renal replacement therapy, paraplegia, and mesenteric ischemia. Pooled meta-analyses with aggregated and reconstructed time-to-event data were performed.
RESULTS
Twenty-three studies were included (aortic: 3904; non-aortic: 10,719). Ten-year overall survival was 61.1 % and 58.4 % for aortic and non-aortic cannulation, respectively (HR 1.07; 95 % CI 0.92-1.25; p = 0.38). No statistically significant difference was observed for operative mortality (p = 0.10), stroke (p = 0.89), renal failure (p = 0.83), or renal replacement therapy (p = 0.77).
CONCLUSION
Patients undergoing surgery for ATAAD can undergo aortic cannulation with similar outcomes to those who undergo non-aortic cannulation.
目的
急性 A 型主动脉夹层（ATAAD）患者的最佳插管策略尚不清楚。
方法
系统检索比较 ATAAD 修复术中主动脉插管与非主动脉插管的所有研究。主要终点是总生存率。次要终点是手术死亡率、术后中风、肾衰竭、肾脏替代治疗、截瘫和肠系膜缺血。对汇总和重建的时间事件数据进行了荟萃分析。
结果
共纳入 23 项研究（主动脉：3904 例；非主动脉：10719 例）。10 年总生存率分别为主动脉插管组 61.1%和非主动脉插管组 58.4%（HR 1.07；95%CI 0.92-1.25；p=0.38）。手术死亡率（p=0.10）、中风（p=0.89）、肾衰竭（p=0.83）或肾脏替代治疗（p=0.77）差异无统计学意义。
结论
接受 ATAAD 手术的患者可采用主动脉插管，其结果与非主动脉插管相似。
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