Baudo Massimo, Rosati Fabrizio, D'Alonzo Michele, Fiore Antonio, Muneretto Claudio, Benussi Stefano, Di Bacco Lorenzo
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA.
Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy.
J Clin Med. 2025 Jul 21;14(14):5170. doi: 10.3390/jcm14145170.
: Acute Stanford Type A aortic dissection (ATAAD) often requires total arch replacement (TAR) with frozen elephant trunk (FET) to address entry tears and support aortic remodeling. In select cases, AMDS may provide a simpler option. The present meta-analysis aims to compare surgical outcomes between these two approaches. : A comprehensive search in the Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases was performed until February 2025. We included studies that reported the outcomes of patients with ATAAD undergoing TAR with AMDS or FET. To enable a meaningful comparison, we only included FET studies where patients met the same inclusion criteria as those with the AMDS. : Thirty-eight articles met our inclusion criteria, with a total of 319 patients in the AMDS group and 4129 in the FET group. Patients undergoing an AMDS procedure experienced significantly higher bleeding requiring surgery (21.2% vs. 6.4%, < 0.001) and a higher hospital mortality (14.5% vs. 10.0%, = 0.037) compared to FET. The individual patient data of 1411 patients were constructed. Overall survival at 1 and 3 years was 81.9% ± 3.3% vs. 88.8% ± 0.9% and 81.9% ± 3.3% vs. 85.2% ± 1.0% between AMDS and FET, respectively. A flexible parametric survival model demonstrated a significant mortality drawback for AMDS compared to FET up to 31 days, beyond which the difference was no longer evident. : The comparison between AMDS and FET for ATAAD treatment remains debated, with FET favored for its lower mortality and stronger long-term evidence. AMDS, as a newer technique, shows promise but lacks sufficient data to confirm its safety and efficacy.
急性 Stanford A 型主动脉夹层（ATAAD）通常需要采用带支架象鼻（FET）的全弓置换术（TAR）来处理破口并支持主动脉重塑。在某些情况下，主动脉夹层去分支手术（AMDS）可能提供一种更简单的选择。本荟萃分析旨在比较这两种方法的手术结果。
在 Pubmed、ScienceDirect、SciELO、DOAJ 和 Cochrane 图书馆数据库中进行了全面检索，直至 2025 年 2 月。我们纳入了报告接受 AMDS 或 FET 的 ATAAD 患者结局的研究。为了进行有意义的比较，我们仅纳入了患者符合与 AMDS 患者相同纳入标准的 FET 研究。
38 篇文章符合我们的纳入标准，AMDS 组共有 319 例患者，FET 组有 4129 例患者。与 FET 相比，接受 AMDS 手术的患者需要手术干预的出血发生率显著更高（21.2% 对 6.4%，< 0.001），且医院死亡率更高（14.5% 对 10.0%， = 0.037）。构建了 1411 例患者的个体患者数据。AMDS 和 FET 之间 1 年和 3 年的总生存率分别为 81.9% ± 3.3% 对 88.8% ± 0.9% 以及 81.9% ± 3.3% 对 85.2% ± 1.0%。一个灵活的参数生存模型显示，与 FET 相比，AMDS 在术后 31 天内存在显著的死亡劣势，超过 31 天后这种差异不再明显。
对于 ATAAD 治疗，AMDS 和 FET 之间的比较仍存在争议，FET 因其较低的死亡率和更强的长期证据而更受青睐。AMDS 作为一种较新的技术显示出前景，但缺乏足够的数据来证实其安全性和有效性。
