Poon et al.[2], 2016 |
2,221 patients from 14 studies |
Systemic review |
In-hospital mortality in hemiarch and TAR groups |
TAR group had longer cross-clamping bypass time |
Big variation in mortality rate in different studies |
High volume centres have good TAR results; if entry is in root and ascending aorta, then hemiarch is adequate |
Uehara et al.[21], 2021 |
34 cases required CPR before surgery (out of a total of 519) |
Retrospective single-centre |
Aortic rupture was the most common cause of CPR (61.8%), followed by coronary malperfusion (13.5%) |
Preoperative neurological deficit, duration of CPR |
|
CPR duration > 15 minutes may be a contraindication for surgery |
Czerny et al.[26], 2015 |
2,137 cases 717 had malperfusion) |
GERAADA analysis |
Cerebral malperfusion (6.8%), visceral malperfusion (3.8%) |
Peripheral malperfusion, coronary malperfusion, preoperative coma, tear in descending aorta, age |
Overall (16.9%), one-organ malperfusion (21.3%) |
Type of dissection and number of organs affected in malperfusion decide the outcome |
Yang et al.[27], 2018 |
597 cases (137 treated with stent first and then index surgery approach) |
Retrospective single-centre |
Aortic rupture (4%) |
Multi-organ malperfusion, index surgery first approach |
First decade of follow-up (21%), second decade (10.7%) |
Risk of dying from MOF was 6.6 times higher compared to the aortic rupture; stable patient with malperfusion can be managed with stent first approach |
Dumfarth et al.[29], 2018 |
303 cases underwent TAAD repair |
Retrospective single-centre |
Overall stroke rate (15.8%), stroke in preoperative CPR cases (18.8%), no CPR cases (3.5%) |
Preoperative CPR, bovine arch, and malperfusion increase the incidence of stroke |
Overall (13.2%), patients with stroke (22.8%) |
Preoperative CPR and preoperative malperfusion syndromes are independent predictors of postoperative stroke |
Ikeno et al.[32], 2021 |
339 cases underwent SCAR |
Retrospective single-centre |
At 5-year follow-up, aortic root-related redo surgery (2.5%), overall deaths (14.5%) |
Dilated SOV, number of commissural detachments |
13.6% |
SOV and commissural detachment are predictors of unfavorable outcomes |
Nishida et al.[33], 2016 |
316 cases underwent ARR during TAAD surgery |
Retrospective single-centre |
Aortic root event (11.6%) in the non-ARR group |
Dissection of > 2 SOV |
ARR group (12.5%), non-ARR group (4.7%) |
ARR reduces future aortic root events |
Conzelmann et al.[37], 2015 |
2,137 TAAD cases treated with surgery |
Multi-centre, GERAADA data |
Mortality of TAAD surgery for septuagenarians (16%) and for octogenarians (35%) |
Age, preoperative coma, CPR, multi-organ malperfusion |
16.9% |
Mortality risk in TAAD patients depends on clinical presentation |
Nortan et al.[39], 2020 |
399 cases underwent TAAD surgery, 190 had arch vessel dissection |
Retrospective single-centre |
Overall, there were no significant differences in major postoperative outcomes between hemiarch and zone 1/2/3 arch groups; 5-year survival: hemiarch (79%) vs. zone 1/2/3 cases (85%) |
Acute MI and cardiogenic shock, hemiarch group had higher reoperation rate at 5-year follow-up (23%) |
Hemiarch group (7%), zone 1/2/3 group (5%) |
Branch alone involvement without malperfusion should not be an indication of debranching |
Eusanio et al.[41], 2014 |
240 cases (53 total arch replacements, 187 hemiarch) |
Retrospective single-centre |
5-year survival for arch and hemiarch group was 65% and 60%, respectively |
Distal entry tear, cardiogenic shock |
Arch group (22%), hemiarch group (24%) |
Aortic and patients’ characteristics greatly influenced the extent of the aortic replacement; 20% of the patients underwent arch replacement |
Yang et al.[43], 2019 |
Hemiarch (322 cases), TAR (150 cases) |
Retrospective single-centre |
Stroke rate was the same in both groups (7% each), 10-year survival was similar (hemiarch 70% vs. TAR 72%) |
Arch > 4 cm, intimal tear in the arch, and branch malperfusion were indications for debranching |
Mortality was similar in both groups (hemiarch 5.3% vs. TAR 7.3%) |
Both hemiarch and TAR are appropriate in the selective cases |
Omura et al.[44], 2016 |
109 hemiarch cases and 88 TAR cases |
Retrospective single-centre |
5-year event rates were low in TAR group |
30% of TAR group cases had entry in the arch |
Hemiarch (14.7%), TAR (10.2%) |
Acceptable TAR mortality with good long-term survival; preoperative CPR and visceral malperfusion are bad indicators |
Preventza et al.[46], 2020 |
3,154 following FET |
Meta-analysis |
SCI (4.7%), stroke (7.6%) |
Higher SCI rate in stent length > 15 cm or coverage of T8 vertebrae |
8.8% |
Unclear outcome, stent length < 10 cm was associated with less SCI |
Ma et al.[48] |
Sun’s procedure |
Retrospective single-centre |
Stroke (19.8%) |
SCI (2.5%) |
7.8% |
Higher mortality seen in patients with stroke, SCI, and low cardiac output |