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Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: a meta-analysis

Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic... OBJECTIVESThe optimal surgical strategy for acute type A aortic dissection (ATAAD) is still controversial because of the inconsistent or even conflicting results of proximal aortic repair (PR) versus extensive aortic repair (ER) on early and late prognostic outcomes. This meta-analysis pooled data from all available studies of PR versus ER to get a summarized conclusion.METHODSStudies were identified by searching the Medline, EMBASE and Cochrane databases. Early and late prognostic outcomes of interest were evaluated with meta-analysis. Fixed- or random-effect models were used according to the significance of heterogeneity. Robustness of pooled estimates and the source of heterogeneity were assessed via sensitivity analyses and meta-regression, respectively. Publication bias was evaluated by the funnel plot and Egger's test.RESULTSNine studies with a total of 1872 patients were included for the meta-analysis. Pooled results indicated that, when compared with the ER procedure, PR was associated with lower early mortality [risk ratio (RR) 0.69, 95 confidence interval (CI) 0.540.90, P 0.005] but higher incidence of postoperative aortic events including reoperation of the distal aorta (RR 3.14, 95 CI 1.745.67, P < 0.001). PR and ER demonstrated analogous prognosis on long-term mortality (HR 1.02, 95 CI 0.512.06, P 0.96) and the incidences of early postoperative renal failure (RR 0.75, 95 CI 0.491.14, P 0.17) and stroke (RR 0.73, 95 CI 0.301.78, P 0.50). All the pooled results were robust to sensitivity analysis. Heterogeneity was insignificant except for the meta-analysis of late mortality.CONCLUSIONSPerforming a less aggressive initial surgical procedure of PR in ATAAD patients would have lower early mortality but elevated incidence rates of late aortic reintervention, when compared with ER. Other prognostic results of the two surgical strategies including long-term mortality were similar for both. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: a meta-analysis

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References (22)

Publisher
Oxford University Press
Copyright
The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1093/ejcts/ezv351
pmid
26464449
Publisher site
See Article on Publisher Site

Abstract

OBJECTIVESThe optimal surgical strategy for acute type A aortic dissection (ATAAD) is still controversial because of the inconsistent or even conflicting results of proximal aortic repair (PR) versus extensive aortic repair (ER) on early and late prognostic outcomes. This meta-analysis pooled data from all available studies of PR versus ER to get a summarized conclusion.METHODSStudies were identified by searching the Medline, EMBASE and Cochrane databases. Early and late prognostic outcomes of interest were evaluated with meta-analysis. Fixed- or random-effect models were used according to the significance of heterogeneity. Robustness of pooled estimates and the source of heterogeneity were assessed via sensitivity analyses and meta-regression, respectively. Publication bias was evaluated by the funnel plot and Egger's test.RESULTSNine studies with a total of 1872 patients were included for the meta-analysis. Pooled results indicated that, when compared with the ER procedure, PR was associated with lower early mortality [risk ratio (RR) 0.69, 95 confidence interval (CI) 0.540.90, P 0.005] but higher incidence of postoperative aortic events including reoperation of the distal aorta (RR 3.14, 95 CI 1.745.67, P < 0.001). PR and ER demonstrated analogous prognosis on long-term mortality (HR 1.02, 95 CI 0.512.06, P 0.96) and the incidences of early postoperative renal failure (RR 0.75, 95 CI 0.491.14, P 0.17) and stroke (RR 0.73, 95 CI 0.301.78, P 0.50). All the pooled results were robust to sensitivity analysis. Heterogeneity was insignificant except for the meta-analysis of late mortality.CONCLUSIONSPerforming a less aggressive initial surgical procedure of PR in ATAAD patients would have lower early mortality but elevated incidence rates of late aortic reintervention, when compared with ER. Other prognostic results of the two surgical strategies including long-term mortality were similar for both.

Journal

European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: May 13, 2016

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