PDF(Pubmed)
Abstract：
UNASSIGNED: Surgical treatment strategy for acute type A aortic dissection (aTAAD) with mesenteric malperfusion (MMP) is quite challenging as it is often associated with poor patient outcomes, and optimal management strategies remain controversial.
UNASSIGNED: We conducted MEDLINE and EMBASE database searches up to December 31, 2021 for studies on aTAAD with MMP. Data on study design, patient demographics, patient management strategy, mortality, complications, and follow-up were extracted, analyzed, and investigated.
UNASSIGNED: Our literature search identified 941 potentially relevant studies, of which 19 were deemed eligible for this study. A total of 352 patients, mean age: 58.4 ± 11.9 years, diagnosed with aTAAD complicated with MMP were included with an overall prevalence of 4%. Patients for which MMP was observed preoperatively were also included in this analysis. The overall in-hospital mortality amongst these patients was 43.5%, and bowel necrosis and/or multiorgan failure were the major causes of death. Four management strategies for first-line treatment were recognized and these included central aortic repair (191, 54.3%), reperfusion of superior mesenteric artery (SMA) (121, 34.3%), exclusively endo-intervention (11, 3.1%), and exclusively medical intervention (29, 8.2%). These various first-line strategies showed mortality rates of 40.3%, 33.9%, 72.7% and 93.1%, respectively. There was no significant difference in the mortality rate between central aortic repair and reperfusion of SMA as first-line therapies ( χ 2 = 1.302, p = 0.254). When compared with central aortic repair and reperfusion of SMA, exclusively medical care exhibited a significantly greater mortality rate (p < 0.01).
UNASSIGNED: aTAAD complicated with MMP is a rare complication that carries a high mortality rate. Central aortic repair and reperfusion of SMA as first-line treatment strategies appear to be associated with better outcomes compared with exclusively endo-intervention and medical care. Clinical decisions may have introduced biases as no differences were indicated in regards to the way patients were being prioritized for the central aortic repair versus reperfusion of SMA. In regards to variable clinical features and pathology of aTAAD complicated with MMP, an individualized approach is recommended.
UNASSIGNED: We conducted MEDLINE and EMBASE database searches up to December 31, 2021 for studies on aTAAD with MMP. Data on study design, patient demographics, patient management strategy, mortality, complications, and follow-up were extracted, analyzed, and investigated.
UNASSIGNED: Our literature search identified 941 potentially relevant studies, of which 19 were deemed eligible for this study. A total of 352 patients, mean age: 58.4 ± 11.9 years, diagnosed with aTAAD complicated with MMP were included with an overall prevalence of 4%. Patients for which MMP was observed preoperatively were also included in this analysis. The overall in-hospital mortality amongst these patients was 43.5%, and bowel necrosis and/or multiorgan failure were the major causes of death. Four management strategies for first-line treatment were recognized and these included central aortic repair (191, 54.3%), reperfusion of superior mesenteric artery (SMA) (121, 34.3%), exclusively endo-intervention (11, 3.1%), and exclusively medical intervention (29, 8.2%). These various first-line strategies showed mortality rates of 40.3%, 33.9%, 72.7% and 93.1%, respectively. There was no significant difference in the mortality rate between central aortic repair and reperfusion of SMA as first-line therapies ( χ 2 = 1.302, p = 0.254). When compared with central aortic repair and reperfusion of SMA, exclusively medical care exhibited a significantly greater mortality rate (p < 0.01).
UNASSIGNED: aTAAD complicated with MMP is a rare complication that carries a high mortality rate. Central aortic repair and reperfusion of SMA as first-line treatment strategies appear to be associated with better outcomes compared with exclusively endo-intervention and medical care. Clinical decisions may have introduced biases as no differences were indicated in regards to the way patients were being prioritized for the central aortic repair versus reperfusion of SMA. In regards to variable clinical features and pathology of aTAAD complicated with MMP, an individualized approach is recommended.
摘要：
■急性A型主动脉夹层（aTAAD）伴肠系膜灌注不良（MMP）的外科治疗策略相当具有挑战性，因为它通常与患者预后不良有关。而最优管理策略仍然存在争议。
■我们在2021年12月31日之前进行了MEDLINE和EMBASE数据库搜索，以进行MMP与aTAAD的研究。研究设计数据，患者人口统计学，患者管理策略,死亡率,并发症,并提取了后续行动，分析,并调查。
■我们的文献检索确定了941项潜在相关研究，其中19人被认为符合本研究的条件.共有352名患者，平均年龄：58.4±11.9岁，被诊断为aTAAD合并MMP的患者被纳入,总体患病率为4%.术前观察到MMP的患者也包括在该分析中。这些患者的总体住院死亡率为43.5%，肠坏死和/或多器官衰竭是死亡的主要原因。一线治疗的四种管理策略被认可，其中包括中央主动脉修复术（191，54.3%），肠系膜上动脉（SMA）再灌注（121，34.3%），独家干预（11，3.1%），和完全医疗干预（29，8.2％）。这些不同的一线策略显示死亡率为40.3%，33.9%,72.7%和93.1%，分别。中心性主动脉修复和SMA再灌注作为一线治疗的死亡率无显著差异(χ2=1.302,p=0.254)。与SMA的中央主动脉修复和再灌注相比，纯医疗保健表现出显著更高的死亡率(p<0.01)。
■aTAAD并发MMP是一种罕见的并发症，具有高死亡率。中心主动脉修复和SMA再灌注作为一线治疗策略似乎与单纯的内干预和医疗护理相比具有更好的预后。临床决策可能引入了偏见，因为在对患者进行中央主动脉修复与SMA再灌注的优先顺序方面没有差异。关于aTAAD并发MMP的可变临床特征和病理，建议采用个性化方法。
■我们在2021年12月31日之前进行了MEDLINE和EMBASE数据库搜索，以进行MMP与aTAAD的研究。研究设计数据，患者人口统计学，患者管理策略,死亡率,并发症,并提取了后续行动，分析,并调查。
■我们的文献检索确定了941项潜在相关研究，其中19人被认为符合本研究的条件.共有352名患者，平均年龄：58.4±11.9岁，被诊断为aTAAD合并MMP的患者被纳入,总体患病率为4%.术前观察到MMP的患者也包括在该分析中。这些患者的总体住院死亡率为43.5%，肠坏死和/或多器官衰竭是死亡的主要原因。一线治疗的四种管理策略被认可，其中包括中央主动脉修复术（191，54.3%），肠系膜上动脉（SMA）再灌注（121，34.3%），独家干预（11，3.1%），和完全医疗干预（29，8.2％）。这些不同的一线策略显示死亡率为40.3%，33.9%,72.7%和93.1%，分别。中心性主动脉修复和SMA再灌注作为一线治疗的死亡率无显著差异(χ2=1.302,p=0.254)。与SMA的中央主动脉修复和再灌注相比，纯医疗保健表现出显著更高的死亡率(p<0.01)。
■aTAAD并发MMP是一种罕见的并发症，具有高死亡率。中心主动脉修复和SMA再灌注作为一线治疗策略似乎与单纯的内干预和医疗护理相比具有更好的预后。临床决策可能引入了偏见，因为在对患者进行中央主动脉修复与SMA再灌注的优先顺序方面没有差异。关于aTAAD并发MMP的可变临床特征和病理，建议采用个性化方法。
