Περίληψη:
Objective Conventional open surgery encompassing cardiopulmonary bypass has been traditionally used for the treatment of ascending aorta diseases. However, more than one in five of these patients will be finally considered unfit for open repair. We conducted a systematic review and meta-analysis to investigate the role of thoracic endovascular aortic repair (TEVAR) for aortic diseases limited to the ascending aorta. Methods The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We investigated patients' baseline characteristics along with early (30 days/in-hospital stay) and late (beyond 30 days/in-hospital stay) outcomes after TEVAR limited to the ascending aorta and not involving the arch vessels. Separate analyses for case reports and case series were conducted, and pooled proportions with 95% confidence intervals (CIs) of outcome rates were calculated. Results Approximately 67% of the patients had a prior cardiac operation. TEVAR was performed mainly for acute or chronic Stanford type A dissection (49%) or pseudoaneurysm (28%). The device was usually delivered through the femoral artery (67%), and rapid ventricular pacing was used in nearly half of the patients. Technical success of the method was 95.5% (95% CI, 87.8-99.8). Among the early outcomes, conversion to open repair was 0.7% (95% CI, 0.1-4.8), whereas mortality was 2.9% (95% CI, 0.02-8.6). We estimated a pooled rate of 1.8% (95% CI, 0.1-7.0) for neurologic events (stroke or transient ischemic attack) and 0.8% (95% CI, 0.1-5.6) for myocardial infarction. Late endoleak was recorded in 16.4% (95% CI, 8.2-26.0), and 4.4% (95% CI, 0.1-12.4) of the population died in the postoperative period. Finally, reoperation was recorded in 8.9% (95% CI, 3.1-16.4) of the study sample. Conclusions TEVAR in the ascending aorta seems to be safe and feasible for selected patients with various aortic diseases, although larger studies are required. © 2017 Society for Vascular Surgery
Συγγραφείς:
Baikoussis, N.G.
Antonopoulos, C.N.
Papakonstantinou, N.A.
Argiriou, M.
Geroulakos, G.
Λέξεις-κλειδιά:
aortic aneurysm; aortic disease; aortic dissection; aortic rupture; aortic thrombosis; ascending aorta; cerebrovascular accident; endoleak; endovascular aneurysm repair; false aneurysm; femoral artery; heart infarction; hematoma; human; length of stay; meta analysis; mortality; priority journal; reoperation; Review; sodium nitroprusside-induced hypotension; systematic review; transient ischemic attack; adult; aged; aorta; Aortic Diseases; blood vessel prosthesis; blood vessel transplantation; devices; diagnostic imaging; endovascular surgery; female; male; middle aged; Postoperative Complications; prosthesis design; risk factor; stent; time factor; treatment outcome; very elderly, Adult; Aged; Aged, 80 and over; Aorta; Aortic Diseases; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Middle Aged; Postoperative Complications; Prosthesis Design; Reoperation; Risk Factors; Stents; Time Factors; Treatment Outcome
