■急性A型主动脉夹层(ATAAD)仍然挑战医生,需要紧急手术治疗。ATAAD手术中减少脑血管事件的两种主要方法是顺行脑灌注(ACP)和逆行脑灌注(RCP)。我们进行了系统评价和荟萃分析,以比较ATAAD手术过程中ACP和RCP方法的结果。
■在这项研究中,我们搜索了数据库直到3月29日,2023年。包括报道ATAAD患者主动脉手术期间不同类型脑灌注保护的比较数据的研究。
■26项研究符合资格标准。所有研究的偏倚风险都很低,因为它们由JoannaBriggs研究所(JBI)关键评估工具进行评估。最终,我们在当前的荟萃分析中纳入了26项研究,总共评估了13,039例患者。ACP和RCP比较中永久性神经功能障碍(PND)的计算风险比(RR)为RR=1.23,95%置信区间(CI):(0.84,1.80)(P值=0.2662),而在单侧ACP(uACP)和双侧ACP(bACP)中RR=1.2786,95%CI:(0.7931,2.0615)(P值=0.3132)。当比较ACP-RCP和uACP-bACP组时,ACP-RCP组之间在停循环时间方面存在显着差异(分别为P值=0.0017和P值=0.1995),体外循环时间(P值=0.5312,P值=0.7460),重症监护病房(ICU)-停留时间(P值=0.2654和P值=0.0099),交叉钳夹时间(P值=0.6228和P值=0.2625),和手术死亡率(分别为P值=0.9368和P值=0.2398),当比较u-ACP和b-ACP组的短暂性神经功能缺损(TND)时,RR为1.32,95%CI:(1.05,1.67)(P值=0.0199)。结果显示异质性高,无发表偏倚。
■这项研究表明,ACP和RCP都是安全且可接受的技术,可用于紧急环境。uACP技术在PND和死亡率方面等同于bACP,然而,就TND而言,uACP优于bACP。
UNASSIGNED: Acute type A aortic dissection (ATAAD) still challenges physicians and warrants emergent surgical management. Two main methods to reduce cerebrovascular events in ATAAD surgeries are antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP). We conducted a systematic
review and meta-analysis to compare the outcomes of ACP and RCP methods during the ATAAD surgery.
UNASSIGNED: In this study, we searched the databases until March 29th, 2023. Studies that reported the data for comparison of different types of brain perfusion protection during aortic surgery in patients with ATAAD were included.
UNASSIGNED: Twenty-six studies met the eligibility criteria. All studies had a low risk of bias as they were evaluated by the Joanna Briggs Institute (JBI) critical appraisal tool. Eventually, we included 26 studies in the current meta-analysis, and a total of 13,039 patients were evaluated. The calculated risk ratio (RR) for permanent neurologic dysfunction (PND) in ACP and RCP comparison was RR =1.23, 95% confidence interval (CI): (0.84, 1.80) (P value =0.2662), and in unilateral ACP (uACP) and bilateral ACP (bACP) was RR =1.2786, 95% CI: (0.7931, 2.0615) (P value =0.3132). When comparing the ACP-RCP and uACP-bACP groups, significant differences were found between ACP-RCP the groups in terms of circulatory arrest time (P value =0.0017 and P value =0.1995, respectively), cardiopulmonary bypass time (P value =0.5312 and P value =0.7460, respectively), intensive care unit (ICU)-stay time (P value =0.2654 and P value =0.0099), crossclamp time (P value =0.6228 and P value =0.2625), and operative mortality (P value =0.9368 and P value =0.2398, respectively), and when comparing the u-ACP and b-ACP groups for transient neurologic deficit (TND), an RR of 1.32, 95% CI: (1.05, 1.67) (P value =0.0199). The results showed high heterogeneity and no publication bias.
UNASSIGNED: This study demonstrated that the ACP and RCP are both safe and acceptable techniques to use in emergent settings. The uACP technique is equivalent to bACP in terms of PND and mortality, however, uACP is preferred over bACP in terms of TND.