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Article: Early and mid-term mortality and morbidity of contemporary international endovascular treatment for type B aortic dissection - A systematic review and meta-analysis

TitleEarly and mid-term mortality and morbidity of contemporary international endovascular treatment for type B aortic dissection - A systematic review and meta-analysis
Authors
KeywordsAortic dissection
Meta-analysis
Morbidity
Mortality
Thoracic endovascular aortic repair
Issue Date2020
PublisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ijcard
Citation
International Journal of Cardiology, 2020, v. 301, p. 56-61 How to Cite?
AbstractBACKGROUND: Effectiveness and optimal timing of endovascular treatment for type B aortic dissection (AD) remain controversial. METHOD: An extensive search of literature (January 1999-December 2017) was conducted using PubMed, Cochrane Library and Science-Direct databases for studies on endovascular repair for acute/chronic type B AD; ≥10 patients; not reviews; and reporting predefined baseline data and ≥50% of predefined study outcomes, which were extracted and analysed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses. Primary outcomes were in-hospital all-cause mortality and aorta-related mortality. RESULT: Based on 92 publications (5956 patients), pooled estimate for overall in-hospital mortality was 7.0% [95% CI, 6.2%-7.8%]. Major perioperative complications included stroke (4.2% [3.6%-4.9%]), spinal cord ischemia (3.3% [2.8%-3.9%]), retrograde type A AD (3.2% [2.7%-3.9%]), type I endoleak (4.9% [3.8%-6.2%]), visceral ischemia (3.1% [2.5%-3.8%]) and acute renal failure requiring haemodialysis (5.1% [4.3%-5.9%]). Mid-term mortality incidence was 8.9% [7.2%-10.9%], and secondary intervention rate was 12.5% [10.5%-15.0%] with 6.1% [5.3%-7.2%] conversion to open surgery. Institutions with ≥40 endovascular treatment caseload had significantly lower rates of in-hospital and aorta-related mortality, stroke, type I endoleak, renal failure and retrograde type A AD. Patients treated in the acute phase had significantly higher incidence of in-hospital or aorta-related mortality and renal failure. Patients with chronic dissection required significantly more often secondary intervention during follow-up. CONCLUSION: Endovascular stent-graft for type B AD therefore appeared feasible and safe with a low incidence of mortality and perioperative complications, particularly for delayed intervention and centres with ≥40 caseload. Standardized and long-term follow-up data are warranted. Copyright © 2019 Elsevier B.V. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/281810
ISSN
2019 Impact Factor: 3.229
2015 SCImago Journal Rankings: 1.513

 

DC FieldValueLanguage
dc.contributor.authorLi, H-L-
dc.contributor.authorWu, S-
dc.contributor.authorChan, YC-
dc.contributor.authorCheng, SW-
dc.contributor.authorXiong, J-
dc.date.accessioned2020-03-27T04:22:48Z-
dc.date.available2020-03-27T04:22:48Z-
dc.date.issued2020-
dc.identifier.citationInternational Journal of Cardiology, 2020, v. 301, p. 56-61-
dc.identifier.issn0167-5273-
dc.identifier.urihttp://hdl.handle.net/10722/281810-
dc.description.abstractBACKGROUND: Effectiveness and optimal timing of endovascular treatment for type B aortic dissection (AD) remain controversial. METHOD: An extensive search of literature (January 1999-December 2017) was conducted using PubMed, Cochrane Library and Science-Direct databases for studies on endovascular repair for acute/chronic type B AD; ≥10 patients; not reviews; and reporting predefined baseline data and ≥50% of predefined study outcomes, which were extracted and analysed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses. Primary outcomes were in-hospital all-cause mortality and aorta-related mortality. RESULT: Based on 92 publications (5956 patients), pooled estimate for overall in-hospital mortality was 7.0% [95% CI, 6.2%-7.8%]. Major perioperative complications included stroke (4.2% [3.6%-4.9%]), spinal cord ischemia (3.3% [2.8%-3.9%]), retrograde type A AD (3.2% [2.7%-3.9%]), type I endoleak (4.9% [3.8%-6.2%]), visceral ischemia (3.1% [2.5%-3.8%]) and acute renal failure requiring haemodialysis (5.1% [4.3%-5.9%]). Mid-term mortality incidence was 8.9% [7.2%-10.9%], and secondary intervention rate was 12.5% [10.5%-15.0%] with 6.1% [5.3%-7.2%] conversion to open surgery. Institutions with ≥40 endovascular treatment caseload had significantly lower rates of in-hospital and aorta-related mortality, stroke, type I endoleak, renal failure and retrograde type A AD. Patients treated in the acute phase had significantly higher incidence of in-hospital or aorta-related mortality and renal failure. Patients with chronic dissection required significantly more often secondary intervention during follow-up. CONCLUSION: Endovascular stent-graft for type B AD therefore appeared feasible and safe with a low incidence of mortality and perioperative complications, particularly for delayed intervention and centres with ≥40 caseload. Standardized and long-term follow-up data are warranted. Copyright © 2019 Elsevier B.V. All rights reserved.-
dc.languageeng-
dc.publisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ijcard-
dc.relation.ispartofInternational Journal of Cardiology-
dc.subjectAortic dissection-
dc.subjectMeta-analysis-
dc.subjectMorbidity-
dc.subjectMortality-
dc.subjectThoracic endovascular aortic repair-
dc.titleEarly and mid-term mortality and morbidity of contemporary international endovascular treatment for type B aortic dissection - A systematic review and meta-analysis-
dc.typeArticle-
dc.identifier.emailChan, YC: ycchan88@hkucc.hku.hk-
dc.identifier.emailCheng, SW: swkcheng@hku.hk-
dc.identifier.authorityChan, YC=rp00530-
dc.identifier.authorityCheng, SW=rp00374-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.ijcard.2019.09.071-
dc.identifier.pmid31748182-
dc.identifier.scopuseid_2-s2.0-85075495372-
dc.identifier.hkuros309551-
dc.identifier.volume301-
dc.identifier.spage56-
dc.identifier.epage61-
dc.publisher.placeIreland-

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