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. 2021 Jun 4;6(6):CD012923.
doi: 10.1002/14651858.CD012923.pub2.

Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms

Ala Elhelali  1 , Niamh Hynes  2 , Declan Devane  1 , Sherif Sultan  3 , Edel P Kavanagh  2 , Liam Morris  4 , Dave Veerasingam  5 , Fionnuala Jordan  1
Affiliations

Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms

Ala Elhelali et al. Cochrane Database Syst Rev. .

Abstract

Background: Thoracic aortic arch aneurysms (TAAs) can be a life-threatening condition due to the potential risk of rupture. Treatment is recommended when the risk of rupture is greater than the risk of surgical complications. Depending on the cause, size and growth rate of the TAA, treatment may vary from close observation to emergency surgery. Aneurysms of the thoracic aorta can be managed by a number of surgical techniques. Open surgical repair (OSR) of aneurysms involves either partial or total replacement of the aorta, which is dependent on the extent of the diseased segment of the aorta. During OSR, the aneurysm is replaced with a synthetic graft. Hybrid repair (HR) involves a combination of open surgery with endovascular aortic stent graft placement. Hybrid repair requires varying degrees of invasiveness, depending on the number of supra-aortic branches that require debranching. The hybrid technique that combines supra-aortic vascular debranching with stent grafting of the aortic arch has been introduced as a therapeutic alternative. However, the short- and long-term outcomes of HR remain unclear, due to technical difficulties and complications as a result of the angulation of the aortic arch as well as handling of the arch during surgery.

Objectives: To assess the effectiveness and safety of HR versus conventional OSR for the treatment of TAAs.

Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 22 March 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations.

Selection criteria: We considered for inclusion in the review all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing HR to OSR for TAAs.

Data collection and analysis: Two review authors independently screened all titles and abstracts obtained from the literature search to identify those that met the inclusion criteria. We retrieved the full text of studies deemed as potentially relevant by at least one review author. The same review authors screened the full-text articles independently for inclusion or exclusion.

Main results: No RCTs or CCTs met the inclusion criteria for this review.

Authors' conclusions: Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of HR compared to OSR in people with TAAs, and we are unable to provide high-certainty evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs are necessary, addressing the objective of this review.

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Conflict of interest statement

AE: Has received funding from Health Research Board (Ireland) under the HRB Cochrane Ireland Fellowship Scheme to undertake a Cochrane Systematic Review (Grant number CTF‐2016‐1863). NH: Has received payment for consultation on Regulatory Documents (Versono Ltd and Integer) and for medical device design at Boston Scientific (Enterprise Ireland Bioinnovate Fellow). Her institution has received payment for provision of training on endovascular aortic repair from Gore Medical. She is investigator in the INSIGHT Post Market Surveillance Trial of the Incraft AAA device (Cordis/Cardinal Health). Her Institution has received payment for an Aortic Fellowship grant (Jotec/Cryolife), and Research fellowship grants (Gore Medical and Medtronic). She declares no competing interests, relationships, conditions or circumstances, which will conflict with this review. DD: None known. SS: Has received payment for training physicians on endovascular aortic repair from Gore Medical and is the Principal Investigator in the INSIGHT post Market Surveillance Trial of the Incraft abdominal aortic endograft (Cordis/Cardinal health). He has declared he has no conflict of interest, which will affect this review. EPK: None known. LM: None known. DV: None known. FJ: Institution received funding from the Health Research Board (Ireland) for a Cochrane Training Fellowship to enable me to undertake a Cochrane Systematic Review over 24 months. This training grant provides me with funding to attend Cochrane Training Programmes/conferences over the two year period of my fellowship.

Figures

1
1
(A) The aortic arch divided into four landing zones for the proximal end of the endograft. (B) Type I: debranching using brachiocephalic bypass grafting and endovascular repair of the aortic arch. This approach is reserved for cases with isolated aortic arch aneurysm that have adequate proximal landing zone 0 in the ascending aorta and distal landing zone in the descending thoracic aorta. (C) Type II: involves an open repair of the ascending aorta and revascularisation of the three branching vessels to create a proximal landing zone for an endovascular graft, which is then deployed to exclude the aneurysm. (D) Type III: consists of an elephant trunk procedure with surgical reconstruction of the aortic arch and revascularisation of the branching vessels of the aortic arch. The surgical graft used to repair the aortic arch is extended in to the descending aorta, where is functions as a landing zone for an endovascular stent graft. This procedure is reserved for patients with extensive aortic lesions involving the ascending aorta, transverse arch and the descending thoracic aorta. "Copyright © [2017] [Oxford University Press on behalf of the European Association for Cardio‐Thoracic Surgery]: reproduced with permission. All rights reserved."
2
2
Study flow diagram.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012923

References

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References to other published versions of this review

Elhelali 2018
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