Systematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection. [Review]

MedStar author(s):
Citation: Journal of Vascular Surgery. 74(5):1721-1731.e4, 2021 11.PMID: 33592292Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Surgery/Vascular SurgeryForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Aneurysm, Dissecting/su [Surgery] | *Aortic Aneurysm/su [Surgery] | *Blood Vessel Prosthesis Implantation | *Endovascular Procedures | Adult | Aged | Aged, 80 and over | Aneurysm, Dissecting/dg [Diagnostic Imaging] | Aneurysm, Dissecting/mo [Mortality] | Aortic Aneurysm/dg [Diagnostic Imaging] | Aortic Aneurysm/mo [Mortality] | Blood Vessel Prosthesis Implantation/ae [Adverse Effects] | Blood Vessel Prosthesis Implantation/mo [Mortality] | Clinical Decision-Making | Endovascular Procedures/ae [Adverse Effects] | Endovascular Procedures/mo [Mortality] | Female | Humans | Male | Middle Aged | Patient Safety | Risk Assessment | Risk Factors | Treatment OutcomeYear: 2021Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0741-5214
Name of journal: Journal of vascular surgeryAbstract: CONCLUSION: The technique for endovascular repair of type A aortic dissection is feasible and reproducible. Meta-analysis of short-term outcomes demonstrate an acceptable safety profile in inoperable patients who otherwise would have an extremely poor prognosis. Data from clinical trials are required before the technique can be introduced into routine clinical practice. Copyright (c) 2021. Published by Elsevier Inc.METHODS: The systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Online literature databases searches were current through April 2020. Demographic and procedural characteristics of individual studies were tabulated. Data on technical success, short-term mortality, stroke and reintervention were extracted and underwent meta-analysis using a random-effects model.OBJECTIVE: The standard surgical approach to Stanford type A aortic dissection is open repair. Up to one-in-four patients are declined surgery due to prohibitive risk. Patients that are managed nonoperatively have an unacceptably high mortality. Endovascular repair of the ascending aorta is emerging as an alternative for a select group of patients. The reported rates of technical success, mortality, stroke and reintervention are variable. The objective of this study is to systematically report on outcomes for acute type A dissections repaired with an endovascular approach.RESULTS: Fourteen studies with 80 aortic dissections (55 acute, 25 subacute) were included in the final analysis. There was wide variation in technique and device design across studies. Outcomes rates were estimated at 17% (95% CI: 10-26%) for mortality, 15% (95% CI: 8-23%) for technical failure, 11% (95% CI: 6-19%) for stroke and 18% (95% CI: 9-31%) for reinterventions. The mean Downs and Black quality assessment score was 13.9 (SD +/-3.2).All authors: Abramowitz SD, De Freitas S, Fatima J, Kiguchi MM, Rossi MJ, Vallabhaneni R, Walsh SR, Woo EYOriginally published: Journal of Vascular Surgery. 2021 Feb 13Fiscal year: FY2021Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-03-10
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 33592292 Available 33592292

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSION: The technique for endovascular repair of type A aortic dissection is feasible and reproducible. Meta-analysis of short-term outcomes demonstrate an acceptable safety profile in inoperable patients who otherwise would have an extremely poor prognosis. Data from clinical trials are required before the technique can be introduced into routine clinical practice. Copyright (c) 2021. Published by Elsevier Inc.

METHODS: The systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Online literature databases searches were current through April 2020. Demographic and procedural characteristics of individual studies were tabulated. Data on technical success, short-term mortality, stroke and reintervention were extracted and underwent meta-analysis using a random-effects model.

OBJECTIVE: The standard surgical approach to Stanford type A aortic dissection is open repair. Up to one-in-four patients are declined surgery due to prohibitive risk. Patients that are managed nonoperatively have an unacceptably high mortality. Endovascular repair of the ascending aorta is emerging as an alternative for a select group of patients. The reported rates of technical success, mortality, stroke and reintervention are variable. The objective of this study is to systematically report on outcomes for acute type A dissections repaired with an endovascular approach.

RESULTS: Fourteen studies with 80 aortic dissections (55 acute, 25 subacute) were included in the final analysis. There was wide variation in technique and device design across studies. Outcomes rates were estimated at 17% (95% CI: 10-26%) for mortality, 15% (95% CI: 8-23%) for technical failure, 11% (95% CI: 6-19%) for stroke and 18% (95% CI: 9-31%) for reinterventions. The mean Downs and Black quality assessment score was 13.9 (SD +/-3.2).

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