Hemostatic Properties of Aortic Root Preservation versus Root Replacement for Acute Type A Aortic Dissection: A Pooled Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy and Article Selection
2.2. Data Extraction and Endpoints
2.3. Subgroup and Sensitivity Analyses on Primary Endpoints
2.4. Quality and Publication Bias Assessment
3. Results
3.1. Search Strategy and Patient Demographics
3.2. Primary Endpoints
3.3. Secondary Endpoints
3.4. Sensitivity Analyses
3.5. Quality and Publication Bias Assessment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Gudbjartsson, T.; Ahlsson, A.; Geirsson, A.; Gunn, J.; Hjortdal, V.; Jeppsson, A.; Mennander, A.; Zindovic, I.; Olsson, C. Acute type A aortic dissection—A review. Scand. Cardiovasc. J. 2019, 54, 1–13. [Google Scholar] [CrossRef] [PubMed]
- Munir, W.; Harky, A.; Bashir, M.; Adams, B. Does adding a root replacement in type A aortic dissection repair provide better outcomes? J. Card. Surg. 2020, 35, 3512–3520. [Google Scholar] [CrossRef] [PubMed]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, 71. [Google Scholar] [CrossRef] [PubMed]
- Higgins, J.P.T.; Green, S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [Updated March 2011]. The Cochrane Collaboration. 2011. Available online: https://www.cochrane-handbook.org (accessed on 15 September 2024).
- Stang, A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur. J. Epidemiol. 2010, 25, 603–605. [Google Scholar] [CrossRef] [PubMed]
- Sterne, J.A.; Hernán, M.A.; Reeves, B.C.; Savović, J.; Berkman, N.D.; Viswanathan, M.; Henry, D.; Altman, D.G.; Ansari, M.T.; Boutron, I.; et al. ROBINS-I: A tool for assessing risk of bias in non-randomized studies of inter-ventions. BMJ 2016, 355, i4919. [Google Scholar] [CrossRef] [PubMed]
- Bojko, M.M.; Assi, R.; Bavaria, J.E.; Suhail, M.; Habertheuer, A.; Hu, R.W.; Harmon, J.; Milewski, R.K.; Desai, N.D.; Szeto, W.Y.; et al. Midterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic dissection. J. Thorac. Cardiovasc. Surg. 2022, 163, 900–910. [Google Scholar] [CrossRef] [PubMed]
- Brown, J.A.; Zhu, J.; Navid, F.; Serna-Gallegos, D.; Sehra, R.; Warraich, N.; Bianco, V.; Aranda-Michel, E.; Sultan, I. Preservation versus replacement of the aortic root for acute type A aortic dissection. J. Thorac. Cardiovasc. Surg. 2024, 167, 2037–2046.e2. [Google Scholar] [CrossRef] [PubMed]
- Castrovinci, S.; Pacini, D.; Di Marco, L.; Berretta, P.; Cefarelli, M.; Murana, G.; Alfonsi, J.; Pantaleo, A.; Leone, A.; Di Eusanio, M.; et al. Surgical management of aortic root in type A acute aortic dissection: A propensity-score analysis. Eur. J. Cardio-Thoracic Surg. 2016, 50, 223–229. [Google Scholar] [CrossRef] [PubMed]
- Dang Van, S.; Laribi, J.; Pinaud, F.; Binuani, P.; Willoteaux, C.; Baufreton, S.; Fouquet, O. Preservation of the Aortic Root During Type A Aortic Dissection Surgery: An Effective Strategy? AORTA 2021, 9, 067–075. [Google Scholar] [CrossRef]
- Fleischman, F.; Elsayed, R.S.; Cohen, R.G.; Tatum, J.M.; Kumar, S.R.; Kazerouni, K.; Mack, W.J.; Barr, M.L.; Cunningham, M.J.; Hackmann, A.E.; et al. Selective Aortic Arch and Root Replacement in Repair of Acute Type A Aortic Dissection. Ann. Thorac. Surg. 2018, 105, 505–512. [Google Scholar] [CrossRef] [PubMed]
- Kallenbach, K.; Büsch, C.; Rylski, B.; Dohle, D.-S.; Krüger, T.; Holubec, T.; Brickwedel, J.; Pöling, J.; Noack, T.; Hagl, C.; et al. Treatment of the aortic root in acute aortic dissection type A: Insights from the German Registry for Acute Aortic Dissection Type A. Eur. J. Cardio-Thoracic Surg. 2022, 62, ezac261. [Google Scholar] [CrossRef] [PubMed]
- Li, X.; Wang, B.; Wang, X.; Wang, Z. The mid-term outcomes of aortic-root repair is not inferior to Bentall procedure in acute type-A aortic dissection. Asian J. Surg. 2024, 47, 911–915. [Google Scholar] [CrossRef] [PubMed]
- Peterss, S.; Dumfarth, J.; Rizzo, J.A.; Bonaros, N.; Fang, H.; Tranquilli, M.; Schachner, T.; Ziganshin, B.A.; Grimm, M.; Elefteriades, J.A. Sparing the aortic root in acute aortic dissection type A: Risk reduction and restored integrity of the untouched root. Eur. J. Cardio-Thoracic Surg. 2016, 50, 232–239. [Google Scholar] [CrossRef] [PubMed]
- Wang, Z.; Greason, K.L.; Pochettino, A.; Schaff, H.V.; Suri, R.M.; Stulak, J.M.; Dearani, J.A. Long-term outcomes of survival and freedom from reoperation on the aortic root or valve after surgery for acute ascending aorta dissection. J. Thorac. Cardiovasc. Surg. 2014, 148, 2117–2122. [Google Scholar] [CrossRef] [PubMed]
- Yang, B.; Norton, E.L.; Hobbs, R.; Farhat, L.; Wu, X.; Hornsby, W.E.; Kim, K.M.; Patel, H.J.; Deeb, G.M. Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: Twenty-year experience. J. Thorac. Cardiovasc. Surg. 2019, 157, 2125–2136. [Google Scholar] [CrossRef] [PubMed]
- Rylski, B.; Beyersdorf, F.; Blanke, P.; Boos, A.; Hoffmann, I.; Dashkevich, A.; Siepe, M. Supracoronary ascending aortic replacement in patients with acute aortic dissection type A: What happens to the aortic root in the long run? J. Thorac. Cardiovasc. Surg. 2013, 146, 285–290. [Google Scholar] [CrossRef] [PubMed]
- Ro, S.K.; Kim, J.B.; Hwang, S.K.; Jung, S.H.; Choo, S.J.; Chung, C.H.; Lee, J.W. Aortic root conservative repair of acute type A aortic dissection involving the aortic root: Fate of the aortic root and aortic valve function. J. Thorac. Cardiovasc. Surg. 2013, 146, 1113–1118. [Google Scholar] [CrossRef] [PubMed]
- Lee, J.H. Prevention and management of difficult hemostasis in acute type A aortic dissection repair. Asian Cardiovasc. Thorac. Ann. 2023, 31, 15–19. [Google Scholar] [CrossRef] [PubMed]
Study ID, Year | Study Design | Patients, n RP/RR | Age, Years RP/RR | Female Sex, % RP/RR | Kidney Disease, % RP/RR | Previous CVA, % RP/RR | Marfan, % RP/RR | Previous CS, % RP/RR | Bicuspid AV, % RP/RR | AV Insufficiency, % RP/RR | NOS |
---|---|---|---|---|---|---|---|---|---|---|---|
Bojko 2020 [7] | R-RA | 131/131 | 56 (48–66)/54 (44–66) | 21/22 | N/A | 7/7 | 0/0 | 11/12 | 8/21 | 65/61 | 8 |
Brown 2022 [8] | R | 370/231 | 63 ± 12/59 ± 15 | 42/37 | N/A | N/A | N/A | 10/16 | 2/8 | 34/54 | 6 |
Castrovinci 2016 [9] | R-RA | 82/82 | 62 ± 12/63 ± 10 | 22/29 | 4/5 | 2/5 | 0/0 | 3/2 | 1/2 | N/A | 7 |
Dang Van 2021 [10] | R | 118/46 | 65 ± 11/52 ± 16 | 40/13 | 2/7 | N/A | 2/9 | 4/4 | 3/11 | 44/66 | 6 |
Fleischman 2018 [11] | R | 148/47 | 62 ± 13/57 ± 16 | 31/21 | 9/6 | 7/6 | 1/6 | 11/26 | N/A | 14/51 | 7 |
Kallenbach 2022 [12] | R | 2425/957 | 63 ± 13/CR: 58 ± 13; VS: 54 ± 14 | 39/CR: 32; VS: 26 | Ν/A | N/A | 2/CR: 5; VS: 9 | N/A | N/A | 26/CR: 57; VS: 11 | 7 |
Li 2024 [13] | R-RA | 447/628 | 57 (52–64)/57 (51–64) | 35/31 | N/A | N/A | N/A | N/A | N/A | 16/18 | 7 |
Peterss 2016 [14] | R | 249/89 | 62 ± 13/56 ± 13 | 34/24 | N/A | 6/7 | N/A | 6/7 | 1/16 | 35/72 | 6 |
Wang 2014 [15] | R | 112/66 | 65 ± 14/53 ± 17 | 17/10 | N/A | 5/11 | 1/8 | 5/11 | 6/24 | 30/65 | 6 |
Yang 2019 [16] | R | 307/184 | 61 (52–59)/56 (44–67) | 36/21 | 6/10 | 2/3 | 0/7 | 7/11 | 3/19 | 27/65 | 7 |
Study ID, Year | Type of Malperfusion, % RP/RR | Tamponade, Rupture, or Shock, % RP/RR | ||||
---|---|---|---|---|---|---|
Cerebral | Coronary | Visceral | Renal | Iliofemoral | ||
Bojko [7] | 26/14 | 6/40 | 23/11 | 3/0 | 34/29 | 24/24 |
Brown [8] | 12/13 | 5/10 | 6/5 | 5/7 | 14/14 | 34/27 |
Castrovinci [9] | 2/5 | N/A | 1/1 | 4/5 | N/A | 8/11 |
Dang Van [10] | N/A | N/A | 5/0 | N/A | 13/9 | 25/22 |
Fleischman [11] | 7/6 | N/A | 7/9 | N/A | 9/11 | 26/25 |
Kallenbach [12] | 13/9 | 8/18 | 7/6 | 9/10 | 7/7 | 21/21 |
Li [13] | 27/23 | N/A | ||||
Peterss [14] | 16/13 | 18/21 | 20/20 | |||
Wang [15] | N/A | N/A | N/A | N/A | N/A | N/A |
Yang [16] | 4/5 | 2/5 | 10/10 | 7/8 | 10/7 | 9/12 |
Study ID, Year | Arch Replacement, % RP/RR | Type of Arterial Cannulation, % RP/RR | Cerebral Perfusion, % RP/RR | Concomitant CABG, % RP/RR | |||||
---|---|---|---|---|---|---|---|---|---|
Hemi-Arch | Total Arch | Axillary | Femoral | Axillary and Femoral | Aortic Arch | ACP | RCP | ||
Bojko [7] | 91/92 | 9/8 | N/A | N/A | N/A | N/A | N/A | N/A | 4/21 |
Brown [8] | 63/65 | 37/35 | 10/8 | 5/6 | N/A | 85/81 | N/A | N/A | 13/17 |
Castrovinci [9] | 71/71 | 11/11 | N/A | N/A | N/A | N/A | N/A | N/A | 27/95 |
Dang Van [10] | 45/35 | 4/7 | N/A | N/A | N/A | N/A | 25/42 | 56/33 | 4/2 |
Fleischman [11] | N/A | N/A | 64/55 | 9/9 | 24/30 | N/A | 80/75 | 15/25 | 7/30 |
Kallenbach [12] | 46/49 | 14/16 | 42/45 | 18/6 | N/A | 5/2 | 70/53 | 2/1 | N/A |
Li [13] | 12/11 | 79/82 | N/A | N/A | N/A | N/A | 88/90 | 12/10 | 8/7 |
Peterss [14] | 81/84 | 16/12 | 36/34 | 57/63 | 6/3 | 39/53 | 16/15 | 10/15 | |
Wang [15] | 70/95 | 30/5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Yang [16] | 58/64 | 8/4 | N/A | N/A | N/A | N/A | 32/27 | 36/41 | 4/9 |
Baseline Characteristics | Arms | WMD/OR * | 95% CI | p-Value | Heterogeneity | |
---|---|---|---|---|---|---|
I2 | p-Value | |||||
Age | 11 | 5.05 | 2.93, 7.916 | <0.01 | 96% | <0.01 |
Female Ratio | 11 | 0.62 | 0.42, 0.93 | 0.02 | 79% | <0.01 |
DM | 6 | 1.14 | 0.84, 1.57 | 0.40 | 0% | 0.93 |
Kidney Disease | 4 | 0.49 | 0.20, 1.18 | 0.11 | 48% | 0.12 |
Previous CVA | 6 | 0.73 | 0.46, 1.16 | 0.18 | 0% | 0.54 |
Marfan | 8 | 0.23 | 0.14, 0.39 | <0.01 | 28% | 0.23 |
Previous CS | 7 | 0.64 | 0.48, 0.86 | <0.01 | 0% | 0.65 |
Bicuspid AV | 6 | 0.20 | 0.12, 0.32 | <0.01 | 29% | 0.22 |
AV Insufficiency | 9 | 0.36 | 0.25, 0.54 | <0.01 | 88% | <0.01 |
Tamponade/Rupture | 9 | 1.04 | 0.90, 1.19 | 0.60 | 0% | 0.75 |
Concomitant CABG | 9 | 0.33 | 0.15, 0.73 | <0.01 | 89% | <0.01 |
Endpoints | Arms | WMD/OR * | 95% CI | p-Value | Heterogeneity | |
---|---|---|---|---|---|---|
I2 | p-Value | |||||
Operative mortality | 10 | 0.88 | 0.71, 1.08 | 0.22 | 27% | 0.19 |
Transfusion of RBCs | 2 | −1.00 | −1.41, −0.59 | <0.01 | 0% | 1.00 |
Reoperations for bleeding | 10 | 0.67 | 0.58, 0.77 | <0.01 | 1% | 0.43 |
Aortic cross-clamp time | 11 | −54.18 | −66.24, −42.12 | <0.01 | 98% | <0.01 |
CPB time | 11 | −48.93 | −55.88, −41.98 | <0.01 | 86% | <0.01 |
Postoperative AKI | 10 | 1.24 | 0.92, 1.69 | 0.16 | 69% | <0.01 |
Prolonged ventilation | 7 | 1.02 | 0.78, 1.34 | 0.89 | 33% | 0.17 |
CVA | 10 | 0.94 | 0.81, 1.10 | 0.47 | 0% | 0.55 |
LOS | 7 | −0.13 | −1.80, 1.54 | 0.88 | 95% | <0.01 |
1-year OS | 6 | 1.01 | 0.76, 1.33 | 0.96 | 52% | 0.06 |
5-year OS | 8 | 0.87 | 0.72, 1.05 | 0.15 | 25% | 0.23 |
1-year reoperation-free OS | 3 | 0.82 | 0.59, 1.13 | 0.22 | 31% | 0.23 |
5-year reoperation-free OS | 7 | 0.86 | 0.66, 1.13 | 0.27 | 61% | 0.02 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Magouliotis, D.E.; Arjomandi Rad, A.; Viviano, A.; Oo, A.Y.; Xanthopoulos, A.; Sicouri, S.; Ramlawi, B.; Athanasiou, T. Hemostatic Properties of Aortic Root Preservation versus Root Replacement for Acute Type A Aortic Dissection: A Pooled Analysis. Life 2024, 14, 1255. https://doi.org/10.3390/life14101255
Magouliotis DE, Arjomandi Rad A, Viviano A, Oo AY, Xanthopoulos A, Sicouri S, Ramlawi B, Athanasiou T. Hemostatic Properties of Aortic Root Preservation versus Root Replacement for Acute Type A Aortic Dissection: A Pooled Analysis. Life. 2024; 14(10):1255. https://doi.org/10.3390/life14101255
Chicago/Turabian StyleMagouliotis, Dimitrios E., Arian Arjomandi Rad, Alessandro Viviano, Aung Ye Oo, Andrew Xanthopoulos, Serge Sicouri, Basel Ramlawi, and Thanos Athanasiou. 2024. "Hemostatic Properties of Aortic Root Preservation versus Root Replacement for Acute Type A Aortic Dissection: A Pooled Analysis" Life 14, no. 10: 1255. https://doi.org/10.3390/life14101255