Safety and effectiveness of proximal aortic repair versus total arch replacement for the treatment of acute type A aortic dissection: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Dazhi ^1,2 ,  LI Xiangwei ² , PANG Feng ² , LUO Jinlong ² , DENG Xin ² , ZHANG Ze ² , HE Xinhong ² , WEI Kequan ²

1. Graduate School, Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, P. R. China;
2. Department of Cadiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region (Guangxi Academy of Medical Sciences), Nanning, 530021, P. R. China;

Corresponding author：

LI Xiangwei, Email: lixiangwei1966@163.com

Keywords：

Acute type A aortic dissection; proximal aortic repair; total arch replacement; complication; mortality; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202205029

Video：

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Objective To evaluate the effectiveness and safety of proximal aortic repair (PAR) versus total arch replacement (TAR) for treatment of acute type A aortic dissection (ATAAD). Methods An electronic search was conducted for clinical controlled studies on PAR versus TAR for patients with ATAAD published in Medline via PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Database and CNKI since their inception up to April 30, 2022. The quality of each study included was assessed by 2 evaluators and the necessary data were extracted. STATA 16 software was used to perform statistical analysis of the available data. Results A total of 28 cohort studies involving 7 923 patients with ATAAD were included in this meta-analysis, of whom 5 710 patients received PAR and 2 213 patients underwent TAR, and 96.43% of the studies (27/28) were rated as high quality. The meta-analysis results showed that: (1) patients who underwent PAR had lower incidences of 30 d mortality [RR=0.62, 95%CI (0.50, 0.77), P＜0.001], in-hospital mortality [RR=0.64, 95%CI (0.54, 0.77), P＜0.001], and neurologic deficiency after surgery [RR=0.84, 95%CI (0.72, 0.98), P=0.032] than those who received TAR; (2) the cardiopulmonary bypass time [WMD=–52.07, 95%CI (–74.19, –29.94), P＜0.001], circulatory arrest time [WMD=–10.14, 95%CI (–15.02, –5.26), P＜0.001], and operation time [WMD=–101.68, 95%CI (–178.63, –24.73), P＜0.001] were significantly shorter in PAR than those in TAR; (3) there was no statistical difference in mortality after discharge, rate of over 5-year survival, renal failure after surgery and re-intervention, volume of red blood cells transfusion and fresh-frozen plasma transfusion, or hospital stay between two surgical procedures. Conclusion Compared with TAR, PAR has a shorter operation time and lower early and in-hospital mortality, but there is no difference in long-term outcomes or complications between the two procedures for patients with ATAAD.

Citation： LI Dazhi, LI Xiangwei, PANG Feng, LUO Jinlong, DENG Xin, ZHANG Ze, HE Xinhong, WEI Kequan. Safety and effectiveness of proximal aortic repair versus total arch replacement for the treatment of acute type A aortic dissection: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(4): 605-613. doi: 10.7507/1007-4848.202205029 Copy

1.	Jassar AS, Sundt TM. How should we manage type A aortic dissection? Gen Thorac Cardiovasc Surg, 2019, 67(1): 137-145.
2.	Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA, 2000, 283(7): 897-903.
3.	Landenhed M, Engström G, Gottsäter A, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: A prospective cohort study. J Am Heart Assoc, 2015, 4(1): e001513.
4.	Melo GER, Mourão M, Caldeira D, et al. A systematic review and meta-analysis of the incidence of acute aortic dissections in population-based studies. J Vasc Surg, 2022, 75(2): 709-720.
5.	Wang JX, Xue YX, Zhu XY, et al. The impact of age in acute type A aortic dissection: A retrospective study. J Cardiothorac Surg, 2022, 17(1): 40.
6.	Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation, 2013, 127(20): 2031-2037.
7.	Gudbjartsson T, Ahlsson A, Geirsson A, et al. Acute type A aortic dissection—A review. Scand Cardiovasc J, 2020, 54(1): 1-13.
8.	Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3): 237-247.
9.	Yang B, Norton EL, Shih T, et al. Late outcomes of strategic arch resection in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2019, 157(4): 1313-1321.
10.	Heo W, Song SW, Lee KH, et al. Surgery for acute type Ⅰ aortic dissection without resection of supra-aortic entry sites leads to unfavourable aortic remodelling. Eur J Cardiothorac Surg, 2018, 54(1): 34-41.
11.	Zierer A, Voeller RK, Hill KE, et al. Aortic enlargement and late reoperation after repair of acute type A aortic dissection. Ann Thorac Surg, 2007, 84(2): 479-486.
12.	Zhu Y, Lingala B, Baiocchi M, et al. Type A aortic dissection-experience over 5 decades: JACC historical breakthroughs in perspective. J Am Coll Cardiol, 2020, 76(14): 1703-1713.
13.	Chiu P, Trojan J, Tsou S, et al. Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation. J Thorac Cardiovasc Surg, 2018, 155(1): 1-7.
14.	Yan Y, Xu L, Zhang H, et al. Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: A meta-analysis. Eur J Cardiothorac Surg, 2016, 49(5): 1392-1401.
15.	Chua M, Ibrahim I, Neo X, et al. Acute aortic dissection in the ED: Risk factors and predictors for missed diagnosis. Am J Emerg Med, 2012, 30(8): 1622-1626.
16.	El-Hamamsy I, Ouzounian M, Demers P, et al. State-of-the-art surgical management of acute type A aortic dissection. Can J Cardiol, 2016, 32(1): 100-109.
17.	Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71.
18.	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(9): 603-605.
19.	Mu X, Wei J, A J, et al. The short-term efficacy and safety of artificial total disc replacement for selected patients with lumbar degenerative disc disease compared with anterior lumbar interbody fusion: A systematic review and meta-analysis. PLoS One, 2018, 13(12): e0209660.
20.	Ohtsubo S, Itoh T, Takarabe K, et al. Surgical results of hemiarch replacement for acute type A dissection. Ann Thorac Surg, 2002, 74(5): S1853-S1856.
21.	Rice RD, Sandhu HK, Leake SS, et al. Is total arch replacement associated with worse outcomes during repair of acute type A aortic dissection? Ann Thorac Surg, 2015, 100(6): 2159-2165.
22.	Aizawa K, Kawahito K, Misawa Y. Long-term outcomes of tear-oriented ascending/hemiarch replacements for acute type A aortic dissection. Gen Thorac Cardiovasc Surg, 2016, 64(7): 403-408.
23.	Lio A, Nicolò F, Bovio E, et al. Total arch versus hemiarch replacement for type A acute aortic dissection: A single-center experience. Tex Heart Inst J, 2016, 43(6): 488-495.
24.	Omura A, Miyahara S, Yamanaka K, et al. Early and late outcomes of repaired acute DeBakey type Ⅰ aortic dissection after graft replacement. J Thorac Cardiovasc Surg, 2016, 151(2): 341-348.
25.	Trivedi D, Navid F, Balzer JR, et al. Aggressive aortic arch and carotid replacement strategy for type A aortic dissection improves neurologic outcomes. Ann Thorac Surg, 2016, 101(3): 896-903.
26.	Kamohara K, Koga S, Takaki J, et al. Long-term durability of preserved aortic root after repair of acute type A aortic dissection. Gen Thorac Cardiovasc Surg, 2017, 65(8): 441-448.
27.	Larsen M, Trimarchi S, Patel HJ, et al. Extended versus limited arch replacement in acute type A aortic dissection. Eur J Cardiothorac Surg, 2017, 52(6): 1104-1110.
28.	Khullar V, Schaff HV, Dearani JA, et al. Open surgical repair remains the gold standard for treating aortic arch pathology. Ann Thorac Surg, 2017, 103(5): 1413-1420.
29.	Colli A, Carrozzini M, Francescato A, et al. Acute DeBakey type Ⅰ aortic dissection without intimal tear in the arch: Is total arch replacement the right choice? Interact Cardiovasc Thorac Surg, 2018, 26(1): 84-90.
30.	Merkle J, Sabashnikov A, Deppe AC, et al. Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection. Ther Adv Cardiovasc Dis, 2018, 12(12): 327-340.
31.	Uchida N, Shibamura H, Katayama A, et al. Operative strategy for acute type A aortic dissection: Ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk. Ann Thorac Surg, 2009, 87(3): 773-777.
32.	Hsu CP, Huang CY, Wu FY. Relationship between the extent of aortic replacement and stent graft for acute DeBakey typeⅠ aortic dissection and outcomes: Results from a medical center in Taiwan. PLoS One, 2019, 14(1): e0210022.
33.	Fichadiya A, Gregory AJ, Kotha VK, et al. Extended-arch repair for acute type-A aortic dissection: Perioperative and mid-term results. Eur J Cardiothorac Surg, 2019, 56(4): 714-721.
34.	Lau C, Robinson NB, Farrington WJ, et al. A tailored strategy for repair of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, S0022-5223(21): 00010-6.
35.	Lee CH, Cho JW, Jang JS, et al. Surgical outcomes of type A aortic dissection at a small-volume medical center: Analysis according to the extent of surgery. Korean J Thorac Cardiovasc Surg, 2020, 53(2): 58-63.
36.	Uchida K, Minami T, Cho T, et al. Results of ascending aortic and arch replacement for type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(4): 1025-1031.
37.	Kimura N, Momose N, Kusadokoro S, et al. Minimized perfusion circuit for acute type A aortic dissection surgery. Artif Organs, 2020, 44(11): E470-E481.
38.	Qin W, Su C, Li L, et al. Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?—Insights from single center experience. J Cardiothorac Surg, 2020, 15(1): 183.
39.	Berdajs DA, Koechlin L, Reid G, et al. Modified frozen elephant trunk procedure as standard approach in acute type A aortic dissection: A propensity-weighted analysis. J Thorac Cardiovasc Surg, 2022, 163(5): 1754-1761.
40.	Kim JB, Chung CH, Moon DH, et al. Total arch repair versus hemiarch repair in the management of acute DeBakey typeⅠ aortic dissection. Eur J Cardiothorac Surg, 2011, 40(4): 881-887.
41.	Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: A new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
42.	Easo J, Weigang E, Hölzl PP, et al. Influence of operative strategy for the aortic arch in DeBakey type Ⅰ aortic dissection: Analysis of the German Registry for Acute Aortic Dissection Type A. J Thorac Cardiovasc Surg, 2012, 144(3): 617-623.
43.	Rylski B, Beyersdorf F, Kari FA, et al. Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair. J Thorac Cardiovasc Surg, 2014, 148(3): 949-954.
44.	Zhang H, Lang X, Lu F, et al. Acute type A dissection without intimal tear in arch: Proximal or extensive repair? J Thorac Cardiovasc Surg, 2014, 147(4): 1251-1255.
45.	Dai XF, Chen LW, Wu XJ, et al. Total aortic arch reconstruction with triple-branched stent graft or hemiarch replacement for acute Debakey type Ⅰ aortic dissection: Five-years experience with 93 patients. J Card Surg, 2015, 30(10): 749-755.
46.	Di Eusanio M, Berretta P, Cefarelli M, et al. Total arch replacement versus more conservative management in type A acute aortic dissection. Ann Thorac Surg, 2015, 100(1): 88-94.
47.	Czerny M, Schmidli J, Adler S, et al. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: An expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg, 2019, 55(1): 133-162.
48.	Heuts S, Adriaans BP, Kawczynski MJ, et al. Editor’s choice—Extending aortic replacement beyond the proximal arch in acute type A aortic dissection: A meta-analysis of short term outcomes and long term actuarial survival. Eur J Vasc Endovasc Surg, 2022, 63(5): 674-687.
49.	Poon SS, Theologou T, Harrington D, et al. Hemiarch versus total aortic arch replacement in acute type A dissection: A systematic review and meta-analysis. Ann Cardiothorac Surg, 2016, 5(3): 156-173.
50.	Kageyama S, Ohashi T, Yoshida T, et al. Early mortality of emergency surgery for acute type A aortic dissection in octogenarians and nonagenarians: A multi-center retrospective study. J Thorac Cardiovasc Surg, 2022, S0022-5223(22): 00199-4.
51.	Gasser S, Stastny L, Kofler M, et al. Type A aortic dissection is more aggressive in women. Eur J Cardiothorac Surg, 2022, 62(2): ezac040.
52.	Zhang K, Pan XD, Dong SB, et al. Cardiopulmonary bypass duration is an independent predictor of adverse outcome in surgical repair for acute type A aortic dissection. J Int Med Res, 2020, 48(11): 300060520968450.
53.	Bashir M, Abo Aljadayel H, Mousavizadeh M, et al. Correlation of coagulopathy and frozen elephant trunk use in aortic arch surgery: A systematic review and meta-analysis. J Card Surg, 2021, 36(12): 4699-4714.

1. Jassar AS, Sundt TM. How should we manage type A aortic dissection? Gen Thorac Cardiovasc Surg, 2019, 67(1): 137-145.
2. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA, 2000, 283(7): 897-903.
3. Landenhed M, Engström G, Gottsäter A, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: A prospective cohort study. J Am Heart Assoc, 2015, 4(1): e001513.
4. Melo GER, Mourão M, Caldeira D, et al. A systematic review and meta-analysis of the incidence of acute aortic dissections in population-based studies. J Vasc Surg, 2022, 75(2): 709-720.
5. Wang JX, Xue YX, Zhu XY, et al. The impact of age in acute type A aortic dissection: A retrospective study. J Cardiothorac Surg, 2022, 17(1): 40.
6. Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation, 2013, 127(20): 2031-2037.
7. Gudbjartsson T, Ahlsson A, Geirsson A, et al. Acute type A aortic dissection—A review. Scand Cardiovasc J, 2020, 54(1): 1-13.
8. Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3): 237-247.
9. Yang B, Norton EL, Shih T, et al. Late outcomes of strategic arch resection in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2019, 157(4): 1313-1321.
10. Heo W, Song SW, Lee KH, et al. Surgery for acute type Ⅰ aortic dissection without resection of supra-aortic entry sites leads to unfavourable aortic remodelling. Eur J Cardiothorac Surg, 2018, 54(1): 34-41.
11. Zierer A, Voeller RK, Hill KE, et al. Aortic enlargement and late reoperation after repair of acute type A aortic dissection. Ann Thorac Surg, 2007, 84(2): 479-486.
12. Zhu Y, Lingala B, Baiocchi M, et al. Type A aortic dissection-experience over 5 decades: JACC historical breakthroughs in perspective. J Am Coll Cardiol, 2020, 76(14): 1703-1713.
13. Chiu P, Trojan J, Tsou S, et al. Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation. J Thorac Cardiovasc Surg, 2018, 155(1): 1-7.
14. Yan Y, Xu L, Zhang H, et al. Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: A meta-analysis. Eur J Cardiothorac Surg, 2016, 49(5): 1392-1401.
15. Chua M, Ibrahim I, Neo X, et al. Acute aortic dissection in the ED: Risk factors and predictors for missed diagnosis. Am J Emerg Med, 2012, 30(8): 1622-1626.
16. El-Hamamsy I, Ouzounian M, Demers P, et al. State-of-the-art surgical management of acute type A aortic dissection. Can J Cardiol, 2016, 32(1): 100-109.
17. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71.
18. 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(9): 603-605.
19. Mu X, Wei J, A J, et al. The short-term efficacy and safety of artificial total disc replacement for selected patients with lumbar degenerative disc disease compared with anterior lumbar interbody fusion: A systematic review and meta-analysis. PLoS One, 2018, 13(12): e0209660.
20. Ohtsubo S, Itoh T, Takarabe K, et al. Surgical results of hemiarch replacement for acute type A dissection. Ann Thorac Surg, 2002, 74(5): S1853-S1856.
21. Rice RD, Sandhu HK, Leake SS, et al. Is total arch replacement associated with worse outcomes during repair of acute type A aortic dissection? Ann Thorac Surg, 2015, 100(6): 2159-2165.
22. Aizawa K, Kawahito K, Misawa Y. Long-term outcomes of tear-oriented ascending/hemiarch replacements for acute type A aortic dissection. Gen Thorac Cardiovasc Surg, 2016, 64(7): 403-408.
23. Lio A, Nicolò F, Bovio E, et al. Total arch versus hemiarch replacement for type A acute aortic dissection: A single-center experience. Tex Heart Inst J, 2016, 43(6): 488-495.
24. Omura A, Miyahara S, Yamanaka K, et al. Early and late outcomes of repaired acute DeBakey type Ⅰ aortic dissection after graft replacement. J Thorac Cardiovasc Surg, 2016, 151(2): 341-348.
25. Trivedi D, Navid F, Balzer JR, et al. Aggressive aortic arch and carotid replacement strategy for type A aortic dissection improves neurologic outcomes. Ann Thorac Surg, 2016, 101(3): 896-903.
26. Kamohara K, Koga S, Takaki J, et al. Long-term durability of preserved aortic root after repair of acute type A aortic dissection. Gen Thorac Cardiovasc Surg, 2017, 65(8): 441-448.
27. Larsen M, Trimarchi S, Patel HJ, et al. Extended versus limited arch replacement in acute type A aortic dissection. Eur J Cardiothorac Surg, 2017, 52(6): 1104-1110.
28. Khullar V, Schaff HV, Dearani JA, et al. Open surgical repair remains the gold standard for treating aortic arch pathology. Ann Thorac Surg, 2017, 103(5): 1413-1420.
29. Colli A, Carrozzini M, Francescato A, et al. Acute DeBakey type Ⅰ aortic dissection without intimal tear in the arch: Is total arch replacement the right choice? Interact Cardiovasc Thorac Surg, 2018, 26(1): 84-90.
30. Merkle J, Sabashnikov A, Deppe AC, et al. Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection. Ther Adv Cardiovasc Dis, 2018, 12(12): 327-340.
31. Uchida N, Shibamura H, Katayama A, et al. Operative strategy for acute type A aortic dissection: Ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk. Ann Thorac Surg, 2009, 87(3): 773-777.
32. Hsu CP, Huang CY, Wu FY. Relationship between the extent of aortic replacement and stent graft for acute DeBakey typeⅠ aortic dissection and outcomes: Results from a medical center in Taiwan. PLoS One, 2019, 14(1): e0210022.
33. Fichadiya A, Gregory AJ, Kotha VK, et al. Extended-arch repair for acute type-A aortic dissection: Perioperative and mid-term results. Eur J Cardiothorac Surg, 2019, 56(4): 714-721.
34. Lau C, Robinson NB, Farrington WJ, et al. A tailored strategy for repair of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, S0022-5223(21): 00010-6.
35. Lee CH, Cho JW, Jang JS, et al. Surgical outcomes of type A aortic dissection at a small-volume medical center: Analysis according to the extent of surgery. Korean J Thorac Cardiovasc Surg, 2020, 53(2): 58-63.
36. Uchida K, Minami T, Cho T, et al. Results of ascending aortic and arch replacement for type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(4): 1025-1031.
37. Kimura N, Momose N, Kusadokoro S, et al. Minimized perfusion circuit for acute type A aortic dissection surgery. Artif Organs, 2020, 44(11): E470-E481.
38. Qin W, Su C, Li L, et al. Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?—Insights from single center experience. J Cardiothorac Surg, 2020, 15(1): 183.
39. Berdajs DA, Koechlin L, Reid G, et al. Modified frozen elephant trunk procedure as standard approach in acute type A aortic dissection: A propensity-weighted analysis. J Thorac Cardiovasc Surg, 2022, 163(5): 1754-1761.
40. Kim JB, Chung CH, Moon DH, et al. Total arch repair versus hemiarch repair in the management of acute DeBakey typeⅠ aortic dissection. Eur J Cardiothorac Surg, 2011, 40(4): 881-887.
41. Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: A new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
42. Easo J, Weigang E, Hölzl PP, et al. Influence of operative strategy for the aortic arch in DeBakey type Ⅰ aortic dissection: Analysis of the German Registry for Acute Aortic Dissection Type A. J Thorac Cardiovasc Surg, 2012, 144(3): 617-623.
43. Rylski B, Beyersdorf F, Kari FA, et al. Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair. J Thorac Cardiovasc Surg, 2014, 148(3): 949-954.
44. Zhang H, Lang X, Lu F, et al. Acute type A dissection without intimal tear in arch: Proximal or extensive repair? J Thorac Cardiovasc Surg, 2014, 147(4): 1251-1255.
45. Dai XF, Chen LW, Wu XJ, et al. Total aortic arch reconstruction with triple-branched stent graft or hemiarch replacement for acute Debakey type Ⅰ aortic dissection: Five-years experience with 93 patients. J Card Surg, 2015, 30(10): 749-755.
46. Di Eusanio M, Berretta P, Cefarelli M, et al. Total arch replacement versus more conservative management in type A acute aortic dissection. Ann Thorac Surg, 2015, 100(1): 88-94.
47. Czerny M, Schmidli J, Adler S, et al. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: An expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg, 2019, 55(1): 133-162.
48. Heuts S, Adriaans BP, Kawczynski MJ, et al. Editor’s choice—Extending aortic replacement beyond the proximal arch in acute type A aortic dissection: A meta-analysis of short term outcomes and long term actuarial survival. Eur J Vasc Endovasc Surg, 2022, 63(5): 674-687.
49. Poon SS, Theologou T, Harrington D, et al. Hemiarch versus total aortic arch replacement in acute type A dissection: A systematic review and meta-analysis. Ann Cardiothorac Surg, 2016, 5(3): 156-173.
50. Kageyama S, Ohashi T, Yoshida T, et al. Early mortality of emergency surgery for acute type A aortic dissection in octogenarians and nonagenarians: A multi-center retrospective study. J Thorac Cardiovasc Surg, 2022, S0022-5223(22): 00199-4.
51. Gasser S, Stastny L, Kofler M, et al. Type A aortic dissection is more aggressive in women. Eur J Cardiothorac Surg, 2022, 62(2): ezac040.
52. Zhang K, Pan XD, Dong SB, et al. Cardiopulmonary bypass duration is an independent predictor of adverse outcome in surgical repair for acute type A aortic dissection. J Int Med Res, 2020, 48(11): 300060520968450.
53. Bashir M, Abo Aljadayel H, Mousavizadeh M, et al. Correlation of coagulopathy and frozen elephant trunk use in aortic arch surgery: A systematic review and meta-analysis. J Card Surg, 2021, 36(12): 4699-4714.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Safety and effectiveness of proximal aortic repair versus total arch replacement for the treatment of acute type A aortic dissection: A systematic review and meta-analysis

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