scholarly journals A systemic review and meta-analysis: Bentall versus David procedure in acute type A aortic dissection

2018 ◽  
Vol 55 (2) ◽  
pp. 201-209 ◽  
Author(s):  
Selim Mosbahi ◽  
Dushaj Stak ◽  
Isaac Gravestock ◽  
Jakob M Burgstaller ◽  
Johann Steurer ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Meta Analysis ◽  
Type A ◽  
Systemic Review ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Hypothermic Circulatory Arrest Time affects neurological outcomes of Frozen Elephant Trunk for Acute Type A Aortic Dissection: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Mostafa Mousavizadeh ◽  
Mahdi Daliri ◽  
Hadi Abo Aljadayel ◽  
Mohammed Idhrees ◽  
Yousef Rezaei ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
Meta Analysis ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Neurological Outcomes ◽  
Neurologic Outcomes

Background: The treatment of complex thoracic aorta pathologies remains a challenge for cardiovascular surgeons. After introducing Frozen Elephant Trunk (FET), a significant evolution of surgical techniques has been achieved. The present meta-analysis aimed to assess the efficacy of FET in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on post-operative neurologic outcomes. Methods: A standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses search was conducted for all observational studies of patients diagnosed with ATAAD undergoing total arch replacement with FET reporting in-hospital mortality, bleeding, and neurological outcomes. A random-effect meta-analysis was performed using STATA software (StataCorp, TX, USA). Results: Thirty-five studies were eligible for the present meta-analysis, including 3211 patients with ATAAD who underwent total arch replacement with FET. The pooled estimate for in-hospital mortality, postoperative stroke, and spinal cord injury were 7% (95% CI 5 – 9; I2 = 68.65%), 5% (95% CI 4 – 7; I2 = 63.93%), and 3% (95% CI 2 – 4; I2 = 19.56%), respectively. Univariate meta-regression revealed that with increasing the duration of hypothermic circulatory arrest time, the effect sizes for postoperative stroke and SCI enhances. Conclusions: It seems that employing the FET procedure for acute type A dissection is associated with acceptable neurologic outcomes and a similar mortality rate comparing with other aorta pathologies. Besides, increasing hypothermic circulation arrest time appears to be a significant predictor of adverse neurologic outcomes after FET.

Reported outcomes after aortic valve resuspension for acute type A aortic dissection: a systematic review and meta-analysis

2019 ◽  
Vol 29 (3) ◽  
pp. 331-338
Author(s):  
Shuang-Kun Chen ◽  
Zhi-Huang Qiu ◽  
Guan-Hua Fang ◽  
Xi-Jie Wu ◽  
Liang-Wan Chen
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Meta Analysis ◽  
Type A ◽  
Acute Type ◽  
Aortic Valve Insufficiency ◽  
Type A Aortic Dissection ◽  
Valve Insufficiency

AbstractIn the majority of patients presenting with acute type A aortic dissection (AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can be preserved by AV resuspension. A meta-analysis was performed to investigate the outcomes following AV resuspension for AAD. A systematic literature search for publications reporting outcomes after AV resuspension in AAD published between January 1998 and June 2018 was conducted. Early outcome events and linearized occurrence rates for late outcome events were derived. The retrieval process yielded 18 unique studies involving 3295 patients with a total of 17 532 patient-years (pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95% CI) 11.5–19.4%, I2 = 91.9%], and the linearized late mortality rate was 3.21%/pt-yrs (95% CI 2.49–3.77, I2 = 29%). The linearized occurrence rates for aortic root reintervention was 1.4%/pt-yrs (95% CI 0.88–1.79, I2 = 48%); for recurrent significant aortic valve insufficiency (>2+), it was 1.12%/pt-yrs (95% CI 0.79–1.45, I2 = 68%); and for endocarditis, it was 0.01%/pt-yrs (95% CI 0–0.04, I2 = 7%). The composite rate of thromboembolism and bleeding was 1.41%/pt-yrs (95% CI 0.18–2.63, I2 = 82%). A more recent surgical period was associated with a decreased hazard of reoperation on the aortic root (P < 0.001). Requirement of AV resuspension alone in AAD is a risk factor for mortality. The long-term durability of AV resuspension is excellent, with low rates of endocarditis and thromboembolism and bleeding. Root reoperation hazard has become acceptable in recent years. Preoperative aortic valve insufficiency grade exceeding 2+ is a predictor for root reoperation.

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

2015 ◽  
Vol 49 (5) ◽  
pp. 1392-1401 ◽  
Author(s):  
Yan Yan ◽  
Li Xu ◽  
Hao Zhang ◽  
Zhi-Yun Xu ◽  
Xue-Yan Ding ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Meta Analysis ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aortic Repair

scholarly journals Classification and outcomes of extended arch repair for acute Type A aortic dissection: a systematic review and meta-analysis

2016 ◽  
pp. ivw355 ◽  
Author(s):  
Holly N. Smith ◽  
Munir Boodhwani ◽  
Maral Ouzounian ◽  
Richard Saczkowski ◽  
Alexander J. Gregory ◽  
...  
Keyword(s):  
Systematic Review ◽  
Aortic Dissection ◽  
Meta Analysis ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

Acute type A aortic dissection in‐hours versus out‐of‐hours: A systematic review and meta‐analysis

2020 ◽  
Vol 35 (12) ◽  
pp. 3432-3439 ◽  
Author(s):  
Steven Toh ◽  
Dominic Choon Men Yew ◽  
Jia Jin Choong ◽  
Tze Lin Chong ◽  
Amer Harky
Keyword(s):  
Systematic Review ◽  
Aortic Dissection ◽  
Meta Analysis ◽  
Type A ◽  
Acute Type ◽  
Out Of Hours ◽  
Type A Aortic Dissection

scholarly journals Is valve-sparing root replacement a safe option in acute type A aortic dissection? A systematic review and meta-analysis

2019 ◽  
Vol 29 (5) ◽  
pp. 766-775 ◽  
Author(s):  
Jinlin Wu ◽  
Yan Huang ◽  
Juntao Qiu ◽  
Bilal Saeed ◽  
Cuntao Yu
Keyword(s):  
Systematic Review ◽  
Infective Endocarditis ◽  
Aortic Dissection ◽  
Meta Analysis ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Bentall Procedure ◽  
Significant Difference ◽  
Valve Sparing

AbstractOBJECTIVESThere are conflicting views regarding the status of valve-sparing root replacement (VSRR) as a proper treatment for acute type A aortic dissection (AAAD). Our goal was to compare the early and late outcomes of VSRR versus those of the Bentall procedure in patients with AAAD.METHODSWe performed a systematic review and meta-analysis of 9 studies to compare the outcomes of VSRR with those of the Bentall procedure in patients with AAAD. We focused on the following issues: early and late mortality rates, re-exploration, thromboembolization/bleeding events, infective endocarditis and reintervention rates.RESULTSA total of 706 patients with AAAD who underwent aortic root surgery were analysed; 254 patients were treated with VSRR and 452 with the Bentall procedure. VSRR was associated with a reduced risk of early death [odds ratio (OR) 0.34; 95% confidence interval (CI) 0.21–0.57] and late death (OR 0.34; 95% CI 0.21–0.57) compared with the Bentall procedure. No statistically significant difference was observed between the VSRR and Bentall groups with pooled ORs (OR 0.77; 95% CI 0.47–1.27, OR 0.61; 95% CI 0.32–1.18 and OR 0.71; 95% CI 0.23–2.15) for re-exploration, thromboembolization/bleeding and postoperative infective endocarditis, respectively. An increased risk of reintervention was observed for the VSRR compared to the Bentall group (OR 3.79; 95% CI 1.27–11.30). The pooled rate of reintervention incidence was 1.6% (95% CI 0.0–3.7%) and 0.4% (95% CI 0.0–1.3%) for the VSRR and the Bentall groups, respectively.CONCLUSIONSVSRR in patients with AAAD can be performed in experienced centres with excellent short- and long-term outcomes compared to those with the Bentall procedure and thus should be recommended especially for active young patients.

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