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Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis

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Abstract

Objectives

Our aim was to compare the safety and efficacy of proximal repair (PR) versus extensive repair (ER) for acute type A aortic dissection (ATAAD).

Methods

A literature search in three databases was performed according to the PRISMA statement. Studies comparing PR versus ER for ATAAD were included. Random-effects meta-analyses were performed.

Results

A total of 27 studies incorporating 7113 patients (PR: 5080; ER: 2033) were included. Patients undergoing PR presented decreased in-hospital mortality (odds ratio [OR]: 0.67 [95% Confidence Interval (95% CI) 0.53–0.85]; p < 0.01) and post-operative bleeding (OR 0.75 [95% CI 0.60–0.95]; p = 0.02) compared to ER. Meta-regression analysis revealed that in-hospital mortality was not influenced by differences regarding the extent of dissection (p = 0.43). Cardiopulmonary bypass time (SMD:-0.93 [95% CI − 1.22, − 0.66]; p < 0.01) and length of hospital stay (SMD:-0.19 [95% CI − 0.34, − 0.05]; p = 0.01) were also lower in the PR group, while there was no difference in terms of renal failure and permanent neurological deficit. The ER approach demonstrated a lower post-discharge mortality compared to PR (OR 1.46 [95% CI 1.09, 1.97]; p = 0.01), while the post-discharge reoperation rate was comparable between the two groups. 1 and 3-year overall survival (OS) were comparable between PR and ER (OR 1.05, [95% CI 0.77–1.44]; p = 0.76) and (OR 1.27 [95% CI 0.86–1.86]; p = 0.23), respectively. The 5-year OS (OR 1.67 [95% CI 1.16–2.41]; p = 0.01) was in favor of the PR arm.

Conclusions

In patients with ATAAD, PR was associated with lower odds of in-hospital mortality but higher odds of late mortality. ER and PR demonstrated similar post-operative complication and reoperation rates.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, University of Thessaly, Larissa, Greece

    Panagiotis T. Tasoudis, Dimitrios E. Magouliotis & Dimitrios N. Varvoglis

  2. Surgery Working Group, Society of Junior Doctors, Athens, Greece

    Panagiotis T. Tasoudis, Dimitrios N. Varvoglis & Ioannis A. Ziogas

  3. Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, W2 1NY, UK

    Mohammad Yousuf Salmasi & Thanos Athanasiou

  4. Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece

    Konstantinos Spanos, Miltiadis Matsagkas & Athanasios Giannoukas

  5. Department of Cardiothoracic Surgery, Oxford University Hospitals, Oxford, UK

    Antonios Kourliouros

  6. Department of Cardiothoracic Surgery, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece

    Dimitrios E. Magouliotis & Thanos Athanasiou

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  1. Panagiotis T. Tasoudis
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Contributions

PTT contributed to conception/design of the work, the acquisition, analysis, interpretation of data, drafting, revision, final approval and is accountable for all aspects of the work. DEM contributed to conception/design of the work, the acquisition, analysis, data interpretation, drafting, revision, final approval and is accountable for all aspects of the work. DNV contributed to conception/design of the work, acquisition, analysis, interpretation of data, drafting, revision, final approval and is accountable for all aspects of the work. IAZ contributed to acquisition, analysis, revision, final approval and is accountable for all aspects of the work. MYS contributed to acquisition, analysis, drafting, final approval and is accountable for all aspects of the work. KS contributed to acquisition, data interpretation, drafting, final approval and is accountable for all aspects of the work. AK contributed to acquisition, data interpretation, revision, final approval and is accountable for all aspects of the work. MM contributed to acquisition, analysis, interpretation of data, drafting, final approval and is accountable for all aspects of the work. AG contributed to acquisition, interpretation of data, drafting, revision, final approval and is accountable for all aspects of the work. TA contributed to conception/design, acquisition, analysis, interpretation of data, drafting, revision, final approval and is accountable for all aspects of the work.

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Correspondence to Dimitrios E. Magouliotis.

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Tasoudis, P.T., Magouliotis, D.E., Varvoglis, D.N. et al. Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis. Gen Thorac Cardiovasc Surg 70, 315–328 (2022). https://doi.org/10.1007/s11748-022-01792-9

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