Open Repair of Descending Thoracic and Thoracoabdominal Aortic Aneurysms: A Meta-Analysis
| Autor: | Michelle Demetres, Cristiano Spadaccio, Mohamed Rahouma, Irbaz Hameed, Leonard N. Girardi, Mario Gaudino, Michelle Chang, Ruan Yongle, Ajita Naik, Faiza M. Khan, Hannah Chen, N. Bryce Robinson |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty 030204 cardiovascular system & hematology Blood Vessel Prosthesis Implantation 03 medical and health sciences Aortic aneurysm Postoperative Complications 0302 clinical medicine medicine Humans Myocardial infarction Stroke Spinal cord injury Aortic Aneurysm Thoracic business.industry Endovascular Procedures Perioperative medicine.disease Abdominal aortic aneurysm Surgery Treatment Outcome 030228 respiratory system Respiratory failure Cardiothoracic surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 110:1941-1949 |
| ISSN: | 0003-4975 |
| Popis: | Background Contemporary outcomes of open repair of thoracoabdominal aortic aneurysms (TAAAs) and descending thoracic aortic aneurysms (DTAs) have not been analyzed in an inclusive meta-analysis. Methods After a systematic literature search, studies from 2008 to 2018 reporting outcomes of open repair of DTAs or TAAAs were pooled in a single-arm meta-analysis performed using the generic inverse variance method. Primary outcome was operative mortality. Secondary outcomes were late mortality, postoperative stroke, permanent and temporary spinal cord injury, renal failure, respiratory failure, and myocardial infarction. Results Fifty-four studies with 12,245 patients were included. Pooled operative mortality for open repair was 10.4% (95% confidence interval [CI], 8.3-12.8): 6.6% (95% CI, 3.7-11.6) for DTA and 10.5% (95% CI, 7.5-14.5) for TAAA. Pooled incidence rate of late mortality was 0.6% (95% CI, 0.5-0.8) per person-year. Pooled rates for postoperative outcomes were 4.9% (95% CI, 3.9-6.1) for stroke; 5.7% (95% CI, 4.3-7.5) and 3.0% (95% CI, 2.1-4.2) for permanent and temporary spinal cord injury, respectively; 13.2% (95% CI, 9.9-17.3) for renal failure; 23.3% (95% CI, 17.5-30.4) for respiratory failure; and 2.7% (95% CI, 1.8-4.1) for myocardial infarction. At metaregression, year of publication, use of the clamp-and-sew technique, and use of the cerebrospinal fluid drain were associated with lower operative mortality. Ruptured aneurysms were associated with higher operative mortality. Conclusions Despite improvement, open repair of DTAs and TAAAs continues to be associated with a considerable risk for operative death and perioperative complications. Use of the cerebrospinal fluid drain is associated with better outcomes. |
| Databáze: | OpenAIRE |
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