Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms.
Journal
The Cochrane database of systematic reviews
ISSN: 1469-493X
Titre abrégé: Cochrane Database Syst Rev
Pays: England
ID NLM: 100909747
Informations de publication
Date de publication:
04 06 2021
04 06 2021
Historique:
entrez:
4
6
2021
pubmed:
5
6
2021
medline:
4
8
2021
Statut:
epublish
Résumé
Thoracic aortic arch aneurysms (TAAs) can be a life-threatening condition due to the potential risk of rupture. Treatment is recommended when the risk of rupture is greater than the risk of surgical complications. Depending on the cause, size and growth rate of the TAA, treatment may vary from close observation to emergency surgery. Aneurysms of the thoracic aorta can be managed by a number of surgical techniques. Open surgical repair (OSR) of aneurysms involves either partial or total replacement of the aorta, which is dependent on the extent of the diseased segment of the aorta. During OSR, the aneurysm is replaced with a synthetic graft. Hybrid repair (HR) involves a combination of open surgery with endovascular aortic stent graft placement. Hybrid repair requires varying degrees of invasiveness, depending on the number of supra-aortic branches that require debranching. The hybrid technique that combines supra-aortic vascular debranching with stent grafting of the aortic arch has been introduced as a therapeutic alternative. However, the short- and long-term outcomes of HR remain unclear, due to technical difficulties and complications as a result of the angulation of the aortic arch as well as handling of the arch during surgery. To assess the effectiveness and safety of HR versus conventional OSR for the treatment of TAAs. The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 22 March 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations. We considered for inclusion in the review all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing HR to OSR for TAAs. Two review authors independently screened all titles and abstracts obtained from the literature search to identify those that met the inclusion criteria. We retrieved the full text of studies deemed as potentially relevant by at least one review author. The same review authors screened the full-text articles independently for inclusion or exclusion. No RCTs or CCTs met the inclusion criteria for this review. Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of HR compared to OSR in people with TAAs, and we are unable to provide high-certainty evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs are necessary, addressing the objective of this review.
Sections du résumé
BACKGROUND
Thoracic aortic arch aneurysms (TAAs) can be a life-threatening condition due to the potential risk of rupture. Treatment is recommended when the risk of rupture is greater than the risk of surgical complications. Depending on the cause, size and growth rate of the TAA, treatment may vary from close observation to emergency surgery. Aneurysms of the thoracic aorta can be managed by a number of surgical techniques. Open surgical repair (OSR) of aneurysms involves either partial or total replacement of the aorta, which is dependent on the extent of the diseased segment of the aorta. During OSR, the aneurysm is replaced with a synthetic graft. Hybrid repair (HR) involves a combination of open surgery with endovascular aortic stent graft placement. Hybrid repair requires varying degrees of invasiveness, depending on the number of supra-aortic branches that require debranching. The hybrid technique that combines supra-aortic vascular debranching with stent grafting of the aortic arch has been introduced as a therapeutic alternative. However, the short- and long-term outcomes of HR remain unclear, due to technical difficulties and complications as a result of the angulation of the aortic arch as well as handling of the arch during surgery.
OBJECTIVES
To assess the effectiveness and safety of HR versus conventional OSR for the treatment of TAAs.
SEARCH METHODS
The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 22 March 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations.
SELECTION CRITERIA
We considered for inclusion in the review all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing HR to OSR for TAAs.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened all titles and abstracts obtained from the literature search to identify those that met the inclusion criteria. We retrieved the full text of studies deemed as potentially relevant by at least one review author. The same review authors screened the full-text articles independently for inclusion or exclusion.
MAIN RESULTS
No RCTs or CCTs met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS
Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of HR compared to OSR in people with TAAs, and we are unable to provide high-certainty evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs are necessary, addressing the objective of this review.
Identifiants
pubmed: 34085713
doi: 10.1002/14651858.CD012923.pub2
pmc: PMC8407084
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
CD012923Subventions
Organisme : Chief Scientist Office
ID : ETM/442
Pays : United Kingdom
Informations de copyright
Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Références
PLoS Med. 2009 Jul 21;6(7):e1000100
pubmed: 19621070
Eur J Vasc Endovasc Surg. 2010 Jun;39(6):683-90
pubmed: 20227895
J Vasc Surg. 2013 Mar;57(3):875-82
pubmed: 23446130
J Vasc Surg. 2016 Jan;63(1):32-8
pubmed: 26432285
J Cardiovasc Surg (Torino). 2018 Aug;59(4):554-558
pubmed: 29687970
J Cardiothorac Vasc Anesth. 2010 Apr;24(2):316-21
pubmed: 19646900
Semin Vasc Surg. 2009 Jun;22(2):119-24
pubmed: 19573752
Gen Thorac Cardiovasc Surg. 2019 Jan;67(1):1-11
pubmed: 29204794
Interact Cardiovasc Thorac Surg. 2017 Jan;24(1):34-40
pubmed: 27659150
Asian Cardiovasc Thorac Ann. 2002 Dec;10(4):318-21
pubmed: 12538276
Eur J Cardiothorac Surg. 2017 Nov 1;52(5):858-866
pubmed: 28977379
J Vasc Surg. 2006 Dec;44(6):1188-97
pubmed: 17145420
Eur J Vasc Endovasc Surg. 2016 May;51(5):674-81
pubmed: 26947541
Ann Cardiothorac Surg. 2018 May;7(3):319-327
pubmed: 30155410
J Vasc Surg. 2014 Jul;60(1):1-10
pubmed: 24636714
Semin Thorac Cardiovasc Surg. 2013 Summer;25(2):107-15
pubmed: 24216527
Eur J Cardiothorac Surg. 2013 Nov;44(5):e325-31
pubmed: 23918768
Vasc Endovascular Surg. 2016 May;50(4):290-4
pubmed: 27075992
Can J Cardiol. 2018 Mar;34(3):262-273
pubmed: 29395709
Ann Cardiothorac Surg. 2013 May;2(3):372-7
pubmed: 23977610
Nat Clin Pract Cardiovasc Med. 2007 Aug;4(8):418-27
pubmed: 17653114
Circulation. 2008 Sep 30;118(14 Suppl):S160-6
pubmed: 18824749
Eur J Cardiothorac Surg. 2012 Dec;42(6):1018-25
pubmed: 22634630
BMJ. 2008 Apr 26;336(7650):924-6
pubmed: 18436948
Ann Cardiothorac Surg. 2013 Mar;2(2):159-62
pubmed: 23977576
Ann Thorac Surg. 2017 May;103(5):1413-1420
pubmed: 27914636
Circulation. 2010 Apr 6;121(13):e266-369
pubmed: 20233780
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2008;:61-8
pubmed: 18396227
Ann Med Surg (Lond). 2017 Jan 31;15:1-8
pubmed: 28203369
J Thorac Cardiovasc Surg. 2015 Dec;150(6):1591-8; discussion 1598-600
pubmed: 26573355
J Vasc Surg. 1994 Feb;19(2):236-46; discussion 247-8
pubmed: 8114185
J Vasc Surg. 2008 Feb;47(2):247-257; discussion 257
pubmed: 18241743
Trials. 2007 Jun 07;8:16
pubmed: 17555582
Circulation. 2006 Dec 12;114(24):2611-8
pubmed: 17145990
Ann Vasc Surg. 2017 Apr;40:94-97
pubmed: 27671454
J Thorac Cardiovasc Surg. 2017 Apr;153(4):767-776
pubmed: 28087112
J Thorac Cardiovasc Surg. 2013 Mar;145(3 Suppl):S178-85
pubmed: 23410777
J Vasc Surg. 2017 Jul;66(1):281-297.e2
pubmed: 28647036
Eur J Vasc Endovasc Surg. 2016 Jun;51(6):791-800
pubmed: 27107487
Ann Cardiothorac Surg. 2013 May;2(3):280-7
pubmed: 23977595
Kardiol Pol. 2016;74(9):994-1001
pubmed: 27040015
Ann Cardiothorac Surg. 2016 May;5(3):156-73
pubmed: 27386403
J Vasc Surg. 2017 Jun;65(6):1584-1590
pubmed: 28222992
Ann Thorac Surg. 2016 Oct;102(4):1190-8
pubmed: 27262912
J Vasc Surg. 2016 Feb;63(2):537-45
pubmed: 26804221
Eur J Cardiothorac Surg. 2017 Feb 1;51(2):329-338
pubmed: 28082472
Cochrane Database Syst Rev. 2016 Jun 06;(6):CD006796
pubmed: 27265222
J Thorac Cardiovasc Surg. 2011 Sep;142(3):630-3
pubmed: 21269650
Ann Thorac Surg. 1995 Jul;60(1):2-6; discussion 7
pubmed: 7598596
Chest. 1992 Aug;102(2):461-6
pubmed: 1643933
Ann Cardiothorac Surg. 2013 May;2(3):247-60
pubmed: 23977592
J Vasc Surg. 2008 Sep;48(3):546-54
pubmed: 18572352
Rev Bras Cir Cardiovasc. 2014 Oct-Dec;29(4):527-36
pubmed: 25714205
J Vasc Surg. 2010 Oct;52(4):1022-33, 1033.e15
pubmed: 20888533
Perfusion. 2017 Apr;32(3):230-237
pubmed: 27815557
Ann Thorac Surg. 2005 Oct;80(4):1475-8
pubmed: 16181890
Curr Vasc Pharmacol. 2017;15(3):230-237
pubmed: 28056759
Bone Joint Res. 2014 Apr 24;3(4):123-9
pubmed: 24764547
J Vasc Surg. 2015 Jan;61(1):88-95
pubmed: 25095745
J Vasc Interv Radiol. 2014 May;25(5):685-692.e5
pubmed: 24529546
J Vasc Surg. 2017 Jun;65(6):1556-1566.e1
pubmed: 28527926
J Thorac Cardiovasc Surg. 1980 Nov;80(5):708-17
pubmed: 7431967
Circulation. 2005 Jul 26;112(4):513-20
pubmed: 16027248
Interact Cardiovasc Thorac Surg. 2016 Jun;22(6):750-5
pubmed: 26932664
Interact Cardiovasc Thorac Surg. 2017 Aug 1;25(2):246-253
pubmed: 28486683
Ann Thorac Surg. 2017 May;103(5):1406-1412
pubmed: 27825691
Zhonghua Yi Xue Za Zhi. 2011 Jun 28;91(24):1668-72
pubmed: 21914313
Ann Thorac Surg. 2017 Jun;103(6):1849-1857
pubmed: 27938888
J Thorac Cardiovasc Surg. 2017 Dec;154(6):1831-1839.e1
pubmed: 28951082
J Am Coll Surg. 2011 Apr;212(4):569-79; discussion 579-81
pubmed: 21463791
Interact Cardiovasc Thorac Surg. 2017 Jun 1;24(6):944-950
pubmed: 28329032
Ann Cardiothorac Surg. 2013 May;2(3):300-2
pubmed: 23977598
Eur Radiol. 2016 Jun;26(6):1613-9
pubmed: 26431707
Clinics (Sao Paulo). 2011;66(1):159-61
pubmed: 21437453
Ann Vasc Surg. 2016 Jul;34:55-61
pubmed: 27179984
Gastroenterology. 2016 Jul;151(1):30-1
pubmed: 27178120
J Thorac Cardiovasc Surg. 2013 Jan;145(1):305-6
pubmed: 23040321
J Thorac Cardiovasc Surg. 1994 Mar;107(3):788-97; discussion 797-9
pubmed: 8127108
Int Surg. 1988 Oct-Dec;73(4):218-20
pubmed: 2978036
Ann Thorac Surg. 2002 Nov;74(5):S1877-80; discussion S1892-8
pubmed: 12440685
Semin Thorac Cardiovasc Surg. 2005 Fall;17(3):274-81
pubmed: 16253833
Eur J Vasc Endovasc Surg. 2019 Feb;57(2):165-198
pubmed: 30318395
J Vasc Surg. 2017 Oct;66(4):1258-1268.e8
pubmed: 28756047
J Cardiothorac Surg. 2016 Jul 12;11(1):104
pubmed: 27406033
J Vasc Surg. 2017 Sep;66(3):687-694
pubmed: 28259577
Ann Thorac Surg. 2001 Jun;71(6):1905-12
pubmed: 11426767
Ann Cardiothorac Surg. 2013 Sep;2(5):680
pubmed: 24109587
BMJ. 2004 Jun 19;328(7454):1490
pubmed: 15205295
Ann Vasc Surg. 2018 Feb;47:305-315
pubmed: 28943484
Circulation. 2014 Apr 15;129(15):1610-6
pubmed: 24733540
Circulation. 1996 Nov 1;94(9 Suppl):II177-81
pubmed: 8901742
J Vasc Surg. 2018 Aug;68(2):325-330
pubmed: 29523439
Curr Atheroscler Rep. 2016 Oct;18(10):60
pubmed: 27663901
J Endovasc Ther. 2010 Apr;17(2):201-9
pubmed: 20426638
J Am Coll Cardiol. 2010 Mar 2;55(9):841-57
pubmed: 20185035
J Cardiovasc Surg (Torino). 2016 Dec;57(6):784-805
pubmed: 27654102
J Vasc Surg. 2016 Jul;64(1):39-45
pubmed: 26994953
Eur J Cardiothorac Surg. 2014 Aug;46(2):248-53; discussion 253
pubmed: 24477738
Adv Exp Med Biol. 2014;802:107-27
pubmed: 24443024
J Vasc Surg. 2017 Oct;66(4):991-996
pubmed: 28400216
J Thorac Cardiovasc Surg. 2012 Dec;144(6):1286-300, 1300.e1-2
pubmed: 22789301
Ann Thorac Surg. 2004 Aug;78(2):596-601
pubmed: 15276529
Ann Surg. 2016 Dec;264(6):1162-1167
pubmed: 26813915
Eur Heart J. 2014 Nov 1;35(41):2873-926
pubmed: 25173340
Eur J Cardiothorac Surg. 2017 Jun 1;51(6):1142-1148
pubmed: 28329146
Cochrane Database Syst Rev. 2021 Jun 4;6:CD012923
pubmed: 34085713
J Thorac Cardiovasc Surg. 2015 Nov;150(5):1140-7.e11
pubmed: 26409997
JAMA. 1998 Dec 9;280(22):1926-9
pubmed: 9851478
Stat Med. 1998 Dec 30;17(24):2815-34
pubmed: 9921604
Ann Cardiothorac Surg. 2018 May;7(3):328-344
pubmed: 30155411
J Endovasc Ther. 2002 Jun;9 Suppl 2:II98-105
pubmed: 12166849
Artif Organs. 1996 Jun;20(6):694-9
pubmed: 8817980
Eur J Cardiothorac Surg. 2007 Apr;31(4):618-22
pubmed: 17254793
J Vasc Surg. 2016 Nov;64(5):1228-1238
pubmed: 27444368
Circulation. 2005 Feb 15;111(6):816-28
pubmed: 15710776
Ann Vasc Surg. 2020 May;65:206-216
pubmed: 31678125
J Thorac Cardiovasc Surg. 2014 Sep;148(3):888-98; discussion 898-900
pubmed: 25052822
J Vasc Surg. 2016 May;63(5):1208-15
pubmed: 26817612
Eur J Vasc Endovasc Surg. 2016 Mar;51(3):380-5
pubmed: 26818022
Ann Thorac Surg. 2014 May;97(5):1569-75
pubmed: 24629302
Arch Surg. 2009 Mar;144(3):222-7
pubmed: 19289660