A meta-analysis of aortic root remodeling and replantation in acute Stanford type A aortic dissection / 中华胸心血管外科杂志

ABSTRACT

Objective:To systematically compare the safety and reliability of remodeling and reimplantation in aortic root valve preservation surgery for acute Stanford type A aortic dissection.Methods:We searched the databases of CNKI, VIP, Wanfang, CBM, Pubmed, EMBASE, Cochrane Central Register of Controlled Trials ( CENTRAL ) to find the clinical controlled research literature on acute type A aortic dissection remodeling and replantation. The relevant outcome indicators were analyzed by Review Manager 5.3 combined with Stata15.0 statistical software.Results:Seven studies involving 356 patients were included. Remodeling surgery versus replantation surgery. There was a higher incidence of postoperative grade Ⅱ or Ⅲ aortic regurgitation( OR=5.56, 95% CI: 1.89-16.41, P<0.05 ), higher 5-year reoperation rate ( OR=7.50, 95% CI: 2.11-26.65, P<0.05 ), shorter cardiopulmonary bypass time ( MD=-20.81, 95% CI: -35.08-6.54, P< 0.05 ), and longer aortic occlusion time ( MD=35.23, 95% CI: 21.21-49.26, P<0.05 ). The 30-day/in-hospital mortality( OR=1.09, 95% CI: 0.56-2.13, P>0.05) , postoperateive secondary thoracotomy for hemostasis( OR=2.91, 95% CI: 0.34-24.99, P>0.05), the rate of reoperation 1 year after surgery( OR=1.22, 95% CI: 0.20-7.56, P> 0.05) and 5-year mortality( OR=7.50, 95% CI: 2.11-26.65, P>0.05), were no significant difference between remodeling surgery group and replantation surgery group. Conclusion:Compared with replantation surgery, remodeling surgery in patients with acute type A aortic dissection has a higher incidence of grade Ⅱ or Ⅲ aortic insufficiency, a higher rate of reoperation 5 years after surgery, a shorter duration of cardiopulmonary bypass, and a longer duration of aortic occlusion. There were no statistically significant differences in postoperative hospitalization/30-day mortality, postoperative secondary thoracotomy, reoperation rate 1 year after surgery, and late mortality using remodeling and replantation techniques, which could be selected according to the actual situation of the aortic root and the experience of the surgeon.