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Comparative effectiveness and safety of open triple‐branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta‐analysis

BACKGROUND: The optimal surgical intervention for Stanford type A aortic dissection is controversial. The aim of this trial sequential meta‐analysis was to investigate the comparative effectiveness and safety of open triple‐branched stent graft and stent elephant trunk implantation for total aortic...

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Autores principales: Bin, Lelin, Fei, Jianbin, Zhao, Long, Hong, Ruofeng, Yang, Wenyu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10100206/
https://www.ncbi.nlm.nih.gov/pubmed/36352782
http://dx.doi.org/10.1111/jocs.16998
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author Bin, Lelin
Fei, Jianbin
Zhao, Long
Hong, Ruofeng
Yang, Wenyu
author_facet Bin, Lelin
Fei, Jianbin
Zhao, Long
Hong, Ruofeng
Yang, Wenyu
author_sort Bin, Lelin
collection PubMed
description BACKGROUND: The optimal surgical intervention for Stanford type A aortic dissection is controversial. The aim of this trial sequential meta‐analysis was to investigate the comparative effectiveness and safety of open triple‐branched stent graft and stent elephant trunk implantation for total aortic arch reconstruction in Sandford type A aortic dissection. METHODS: PubMed, Embase, Cochrane library, Chinese Biomedical Literature database (CBM), and China National Knowledge Infrastructure (CNKI) were searched for retrieving relevant studies from inception to February 28, 2022. We evaluated 30‐day mortality, procedure‐related time including cardiopulmonary bypass (CPB), aortic cross‐clamp (ACC), and selective cerebral perfusion (SCP), the incidence of postoperative complications including paralysis, cerebral embolism, and acute renal failure, intensive care unit (ICU) time, and medical expenditure. Statistical analysis was performed by RevMan 5.4 and trial sequential analysis (TSA) software. RESULTS: Six studies involving 260 dissection cases were included eventually. Total aortic arch reconstruction with open triple‐branched stent graft was comparable to the stented elephant trunk implantation in 30‐day mortality, incidence of postoperative complications, ICU time, and medical expenditure, but open triple‐branched stent graft was related to shorter procedure‐related time including CPB (mean difference [MD] = −46.11, 95% confidence interval [CI] = −67.24 to −24.98, p < .001), ACC (MD = −42.82, 95% CI = −66.74 to −18.90, p < .001), and SCP (MD = −17.88, 95% CI = −33.36 to −2.39, p = .02). TSA confirmed robustness of findings. CONCLUSIONS: Our analysis suggested that total aortic arch reconstruction with open triple‐branched stent graft may be an effective and simplified procedure than the stented elephant trunk implantation.
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spelling pubmed-101002062023-04-14 Comparative effectiveness and safety of open triple‐branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta‐analysis Bin, Lelin Fei, Jianbin Zhao, Long Hong, Ruofeng Yang, Wenyu J Card Surg Regular Issue Papers BACKGROUND: The optimal surgical intervention for Stanford type A aortic dissection is controversial. The aim of this trial sequential meta‐analysis was to investigate the comparative effectiveness and safety of open triple‐branched stent graft and stent elephant trunk implantation for total aortic arch reconstruction in Sandford type A aortic dissection. METHODS: PubMed, Embase, Cochrane library, Chinese Biomedical Literature database (CBM), and China National Knowledge Infrastructure (CNKI) were searched for retrieving relevant studies from inception to February 28, 2022. We evaluated 30‐day mortality, procedure‐related time including cardiopulmonary bypass (CPB), aortic cross‐clamp (ACC), and selective cerebral perfusion (SCP), the incidence of postoperative complications including paralysis, cerebral embolism, and acute renal failure, intensive care unit (ICU) time, and medical expenditure. Statistical analysis was performed by RevMan 5.4 and trial sequential analysis (TSA) software. RESULTS: Six studies involving 260 dissection cases were included eventually. Total aortic arch reconstruction with open triple‐branched stent graft was comparable to the stented elephant trunk implantation in 30‐day mortality, incidence of postoperative complications, ICU time, and medical expenditure, but open triple‐branched stent graft was related to shorter procedure‐related time including CPB (mean difference [MD] = −46.11, 95% confidence interval [CI] = −67.24 to −24.98, p < .001), ACC (MD = −42.82, 95% CI = −66.74 to −18.90, p < .001), and SCP (MD = −17.88, 95% CI = −33.36 to −2.39, p = .02). TSA confirmed robustness of findings. CONCLUSIONS: Our analysis suggested that total aortic arch reconstruction with open triple‐branched stent graft may be an effective and simplified procedure than the stented elephant trunk implantation. John Wiley and Sons Inc. 2022-11-09 2022-12 /pmc/articles/PMC10100206/ /pubmed/36352782 http://dx.doi.org/10.1111/jocs.16998 Text en © 2022 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Regular Issue Papers
Bin, Lelin
Fei, Jianbin
Zhao, Long
Hong, Ruofeng
Yang, Wenyu
Comparative effectiveness and safety of open triple‐branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta‐analysis
title Comparative effectiveness and safety of open triple‐branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta‐analysis
title_full Comparative effectiveness and safety of open triple‐branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta‐analysis
title_fullStr Comparative effectiveness and safety of open triple‐branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta‐analysis
title_full_unstemmed Comparative effectiveness and safety of open triple‐branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta‐analysis
title_short Comparative effectiveness and safety of open triple‐branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta‐analysis
title_sort comparative effectiveness and safety of open triple‐branched stent graft technique with stented elephant trunk implantation in treating stanford type a aortic dissection: a trial sequential meta‐analysis
topic Regular Issue Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10100206/
https://www.ncbi.nlm.nih.gov/pubmed/36352782
http://dx.doi.org/10.1111/jocs.16998
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