PDF(Pubmed)
Abstract：
OBJECTIVE: Cerebral malperfusion (CM) is a common comorbidity in acute type A aortic dissection (ATAAD), which is associated with high mortality and poor neurological prognosis. This meta-analysis investigated the surgical strategy of ATAAD patients with CM, aiming to compare the difference in therapeutic effectiveness between the central repair-first and the early reperfusion-first according to clinical outcomes.
METHODS: The meta-analysis and systematic review was conducted based on studies sourced from the PubMed, Embase, and Cochrane literature database, in which cases of ATAAD with CM underwent surgical repair were included. Data for baseline characteristics, mortality, survival were extracted, and risk ratio (RR) values and the pooled mortality were calculated.
RESULTS: A total of 17 retrospective studies were analyzed, including 1010 cases of ATAAD with CM underwent surgical repair. The pooled early mortality in early reperfusion group was lower (8.1%; CI, 0.02 to 0.168) than that in the central repair group (16.2%; CI, 0.115 to 0.216). The pooled long-term mortality was 7.9% in the early reperfusion cohort and 17.4% the central repair-first cohort, without a statistically significant heterogeneity (I [2] = 51.271%; p = 0.056). The mean time of symptom-onset-to-the-operation-room in all the reports was 8.87 ± 12.3 h.
CONCLUSIONS: This meta-analysis suggested that early reperfusion-first may achieved better outcomes compared to central repair-first in ATAAD patients complicated with CM to some extent. Early operation and early restoration of cerebral perfusion may reduce the occurrence of some neurological complications.
BACKGROUND: The meta-analysis was registered in the International Prospective Register of Systematic Reviews database (No. CRD CRD42023475629) on Nov. 8th, 2023.
METHODS: The meta-analysis and systematic review was conducted based on studies sourced from the PubMed, Embase, and Cochrane literature database, in which cases of ATAAD with CM underwent surgical repair were included. Data for baseline characteristics, mortality, survival were extracted, and risk ratio (RR) values and the pooled mortality were calculated.
RESULTS: A total of 17 retrospective studies were analyzed, including 1010 cases of ATAAD with CM underwent surgical repair. The pooled early mortality in early reperfusion group was lower (8.1%; CI, 0.02 to 0.168) than that in the central repair group (16.2%; CI, 0.115 to 0.216). The pooled long-term mortality was 7.9% in the early reperfusion cohort and 17.4% the central repair-first cohort, without a statistically significant heterogeneity (I [2] = 51.271%; p = 0.056). The mean time of symptom-onset-to-the-operation-room in all the reports was 8.87 ± 12.3 h.
CONCLUSIONS: This meta-analysis suggested that early reperfusion-first may achieved better outcomes compared to central repair-first in ATAAD patients complicated with CM to some extent. Early operation and early restoration of cerebral perfusion may reduce the occurrence of some neurological complications.
BACKGROUND: The meta-analysis was registered in the International Prospective Register of Systematic Reviews database (No. CRD CRD42023475629) on Nov. 8th, 2023.
摘要：
目的：脑灌注不良（CM）是急性A型主动脉夹层（ATAAD）的常见合并症，这与高死亡率和不良的神经系统预后有关。这项荟萃分析调查了ATAAD合并CM患者的手术策略。旨在根据临床结果比较中枢修复优先和早期再灌注优先之间的治疗效果差异。
方法：荟萃分析和系统评价是基于来自PubMed的研究，Embase,和Cochrane文献数据库，其中包括ATAAD伴CM接受手术修复的病例。基线特性数据，死亡率,生存被提取，计算风险比(RR)值和合并死亡率.
结果：共分析了17项回顾性研究，其中1010例ATAAD合并CM行手术修复。早期再灌注组的合并早期死亡率（8.1％；CI，0.02至0.168）低于中央修复组（16.2％；CI，0.115至0.216）。合并的长期死亡率在早期再灌注队列中为7.9％，在中央修复优先队列中为17.4％。没有统计学上显著的异质性(I[2]=51.271%；p=0.056)。所有报告中症状发作到手术室的平均时间为8.87±12.3h。
结论：这项荟萃分析提示，在ATAAD合并CM的患者中，早期再灌注优先可能比中枢修复优先获得更好的结果。早期手术和早期恢复脑灌注可以减少一些神经系统并发症的发生。
背景：荟萃分析已在国际前瞻性系统评价注册数据库中注册（编号：CRDCRD42023475629)于11月8th,2023年。
方法：荟萃分析和系统评价是基于来自PubMed的研究，Embase,和Cochrane文献数据库，其中包括ATAAD伴CM接受手术修复的病例。基线特性数据，死亡率,生存被提取，计算风险比(RR)值和合并死亡率.
结果：共分析了17项回顾性研究，其中1010例ATAAD合并CM行手术修复。早期再灌注组的合并早期死亡率（8.1％；CI，0.02至0.168）低于中央修复组（16.2％；CI，0.115至0.216）。合并的长期死亡率在早期再灌注队列中为7.9％，在中央修复优先队列中为17.4％。没有统计学上显著的异质性(I[2]=51.271%；p=0.056)。所有报告中症状发作到手术室的平均时间为8.87±12.3h。
结论：这项荟萃分析提示，在ATAAD合并CM的患者中，早期再灌注优先可能比中枢修复优先获得更好的结果。早期手术和早期恢复脑灌注可以减少一些神经系统并发症的发生。
背景：荟萃分析已在国际前瞻性系统评价注册数据库中注册（编号：CRDCRD42023475629)于11月8th,2023年。
