Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Apr;70(4):315-328.
doi: 10.1007/s11748-022-01792-9. Epub 2022 Feb 26.

Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis

Panagiotis T Tasoudis  1   2 , Dimitrios E Magouliotis  3   4 , Dimitrios N Varvoglis  1   2 , Ioannis A Ziogas  2 , Mohammad Yousuf Salmasi  5 , Konstantinos Spanos  6 , Antonios Kourliouros  7 , Miltiadis Matsagkas  6 , Athanasios Giannoukas  6 , Thanos Athanasiou  5   8
Affiliations
Meta-Analysis

Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis

Panagiotis T Tasoudis et al. Gen Thorac Cardiovasc Surg. 2022 Apr.

Abstract

Objectives: Our aim was to compare the safety and efficacy of proximal repair (PR) versus extensive repair (ER) for acute type A aortic dissection (ATAAD).

Methods: A literature search in three databases was performed according to the PRISMA statement. Studies comparing PR versus ER for ATAAD were included. Random-effects meta-analyses were performed.

Results: A total of 27 studies incorporating 7113 patients (PR: 5080; ER: 2033) were included. Patients undergoing PR presented decreased in-hospital mortality (odds ratio [OR]: 0.67 [95% Confidence Interval (95% CI) 0.53-0.85]; p < 0.01) and post-operative bleeding (OR 0.75 [95% CI 0.60-0.95]; p = 0.02) compared to ER. Meta-regression analysis revealed that in-hospital mortality was not influenced by differences regarding the extent of dissection (p = 0.43). Cardiopulmonary bypass time (SMD:-0.93 [95% CI - 1.22, - 0.66]; p < 0.01) and length of hospital stay (SMD:-0.19 [95% CI - 0.34, - 0.05]; p = 0.01) were also lower in the PR group, while there was no difference in terms of renal failure and permanent neurological deficit. The ER approach demonstrated a lower post-discharge mortality compared to PR (OR 1.46 [95% CI 1.09, 1.97]; p = 0.01), while the post-discharge reoperation rate was comparable between the two groups. 1 and 3-year overall survival (OS) were comparable between PR and ER (OR 1.05, [95% CI 0.77-1.44]; p = 0.76) and (OR 1.27 [95% CI 0.86-1.86]; p = 0.23), respectively. The 5-year OS (OR 1.67 [95% CI 1.16-2.41]; p = 0.01) was in favor of the PR arm.

Conclusions: In patients with ATAAD, PR was associated with lower odds of in-hospital mortality but higher odds of late mortality. ER and PR demonstrated similar post-operative complication and reoperation rates.

Keywords: Aortic dissection; Ataad; Extensive repair; Proximal repair.

PubMed Disclaimer

References

    1. LeMaire SA, Russell L. Epidemiology of thoracic aortic dissection. Nat Rev Cardiol. 2011;8(2):103–13. https://doi.org/10.1038/nrcardio.2010.187 . - DOI - PubMed
    1. Abe T, Yamamoto H, Miyata H, et al. Patient trends and outcomes of surgery for type A acute aortic dissection in Japan: an analysis of more than 10 000 patients from the Japan Cardiovascular Surgery Database. Eur J Cardiothorac Surg. 2020;57(4):660–7. https://doi.org/10.1093/ejcts/ezz323 . - DOI - PubMed
    1. Larsen M, Trimarchi S, Patel HJ, et al. Extended versus limited arch replacement in acute type A aortic dissection. Eur J Cardiothorac Surg. 2017;52(6):1104–10. https://doi.org/10.1093/EJCTS/EZX214 . - DOI - PubMed
    1. Easo J, Weigang E, Hölzl PPF, et al. Influence of operative strategy for the aortic arch in DeBakey type i aortic dissection: analysis of the german registry for acute aortic dissection type A. J Thorac Cardiovasc Surg. 2012;144(3):617–23. https://doi.org/10.1016/j.jtcvs.2011.07.066 . - DOI - PubMed
    1. Sakaguchi G, Komiya T, Tamura N, et al. Patency of distal false lumen in acute dissection: extent of resection and prognosis. Interact Cardiovasc Thorac Surg. 2007;6(2):204–7. https://doi.org/10.1510/icvts.2006.132233 . - DOI - PubMed

LinkOut - more resources