TY - JOUR
T1 - Hybrid repair versus conventional open repair for aortic arch dissection
AU - Kavanagh, Edel P.
AU - Sultan, Sherif
AU - Jordan, Fionnuala
AU - Elhelali, Ala
AU - Devane, Declan
AU - Veerasingam, Dave
AU - Hynes, Niamh
N1 - Funding Information:
We are very grateful to Cochrane Vascular for their support and guidance in the preparation of this review. The review authors and the Cochrane Vascular editorial base are grateful to the following peer reviewers for their time and comments: Piergiorgio Cao FRCS, Senior Professor of Vascular Surgery, University of Perugia; Consultant Vascular Surgeon, Ospedale Bel Colle Viterbo, Clinica Mater Dei Roma, Rome, Italy; Mr Stephen Badger, Belfast Health & Social Care Trust, Belfast, UK.
Funding Information:
The Cochrane Vascular editorial base is supported by the Chief Scientist Office.
Funding Information:
EPK: none known. SS: SS and his institution have received payment from Gore Medical for training physicians on endovascular aortic repair. SS is the Principal Investigator in the INSIGHT post Market Surveillance trial of the INCRAFT abdominal aortic endograJ (Cordis/Cardinal health). He reports he has no conflict of interest which will affect this review. FJ: Institution received funding from the Health Research Board (Ireland) for a Cochrane Training Fellowship to enable me to undertake a Cochrane Systematic Review over 24 months. This training grant provides me with funding to attend Cochrane Training Programmes/ conferences over the two year period of my fellowship. AE: has received funding from Health Research Board (Ireland) under the HRB Cochrane Ireland Fellowship Scheme to undertake a Cochrane Systematic Review (Elhelali 2021) (Grant number CTF-2016-1863). DD: none known. DV: none known. NH: has received payment for consultation on Regulatory Documents (Versono Ltd and Integer) and for working on medical device design at Boston Scientific (Enterprise Ireland Bioinnovate Fellow). Her institution has received payment for provision of training on endovascular aortic repair from Gore Medical. She is investigator in the INSIGHT Post Market Surveillance Trial of the IncraJ AAA device (Cordis/Cardinal Health). Her Institution has received payment for an Aortic Fellowship grant (Jotec/Cryolife), and Research fellowship grants (Gore Medical and Medtronic). She declares no competing interests, relationships, conditions or circumstances, which will conflict with this review.
Publisher Copyright:
Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
PY - 2021/7/25
Y1 - 2021/7/25
N2 - Background: A dissection of the aorta is a separation or tear of the intima from the media. This tear allows blood to flow not only through the original aortic flow channel (known as the true lumen), but also through a second channel between the intima and media (known as the false lumen). Aortic dissection is a life-threatening condition which can be rapidly fatal. There is debate on the optimal surgical approach for aortic arch dissection. People with ascending aortic dissection have poor rates of survival. Currently open surgical repair is regarded as the standard treatment for aortic arch dissection. We intend to review the role of hybrid and open repair in aortic arch dissection. Objectives: To assess the effectiveness and safety of a hybrid technique of treatment over conventional open repair in the management of aortic arch dissection. 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 8 February 2021. We also undertook reference checking for additional studies. Selection criteria: We included randomised controlled trials (RCTs) and clinical controlled trials (CCTs), which compared the effects of hybrid repair techniques versus open surgical repair of aortic arch dissection. Outcomes of interest were dissection-related mortality and all-cause mortality, neurological deficit, cardiac injury, respiratory compromise, renal ischaemia, false lumen thrombosis (defined by partial or complete thrombosis) and mesenteric ischaemia. Data collection and analysis: Two review authors independently screened all records identified by the literature searches to identify those that met our inclusion criteria. We planned to undertake data collection and analysis in accordance with recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions. We planned to assess the certainty of the evidence using GRADE. Main results: We identified one ongoing study and two unpublished studies that met the inclusion criteria for the review. Due to a lack of study data, we could not compare the outcomes of hybrid repair to conventional open repair for aortic arch dissection. Authors' conclusions: This review revealed one ongoing RCT and two unpublished RCTs evaluating hybrid versus conventional open repair for aortic arch surgery. Observational data suggest that hybrid repair for aortic arch dissection could potentially be favourable, but conclusions can not be drawn from these studies, which are highly selective, and are based on the clinical status of the patient, the presence of comorbidities and the skills of the operators. However, a conclusion about its definitive benefit over conventional open surgical repair cannot be made from this review without published RCTs or CCTs. Future RCTs or CCTs need to have adequate sample sizes and follow-up, and assess clinically-relevant outcomes, in order to determine the optimal treatment for people with aortic arch dissection. It must be noted that this may not be feasible, due to the reasons mentioned.
AB - Background: A dissection of the aorta is a separation or tear of the intima from the media. This tear allows blood to flow not only through the original aortic flow channel (known as the true lumen), but also through a second channel between the intima and media (known as the false lumen). Aortic dissection is a life-threatening condition which can be rapidly fatal. There is debate on the optimal surgical approach for aortic arch dissection. People with ascending aortic dissection have poor rates of survival. Currently open surgical repair is regarded as the standard treatment for aortic arch dissection. We intend to review the role of hybrid and open repair in aortic arch dissection. Objectives: To assess the effectiveness and safety of a hybrid technique of treatment over conventional open repair in the management of aortic arch dissection. 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 8 February 2021. We also undertook reference checking for additional studies. Selection criteria: We included randomised controlled trials (RCTs) and clinical controlled trials (CCTs), which compared the effects of hybrid repair techniques versus open surgical repair of aortic arch dissection. Outcomes of interest were dissection-related mortality and all-cause mortality, neurological deficit, cardiac injury, respiratory compromise, renal ischaemia, false lumen thrombosis (defined by partial or complete thrombosis) and mesenteric ischaemia. Data collection and analysis: Two review authors independently screened all records identified by the literature searches to identify those that met our inclusion criteria. We planned to undertake data collection and analysis in accordance with recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions. We planned to assess the certainty of the evidence using GRADE. Main results: We identified one ongoing study and two unpublished studies that met the inclusion criteria for the review. Due to a lack of study data, we could not compare the outcomes of hybrid repair to conventional open repair for aortic arch dissection. Authors' conclusions: This review revealed one ongoing RCT and two unpublished RCTs evaluating hybrid versus conventional open repair for aortic arch surgery. Observational data suggest that hybrid repair for aortic arch dissection could potentially be favourable, but conclusions can not be drawn from these studies, which are highly selective, and are based on the clinical status of the patient, the presence of comorbidities and the skills of the operators. However, a conclusion about its definitive benefit over conventional open surgical repair cannot be made from this review without published RCTs or CCTs. Future RCTs or CCTs need to have adequate sample sizes and follow-up, and assess clinically-relevant outcomes, in order to determine the optimal treatment for people with aortic arch dissection. It must be noted that this may not be feasible, due to the reasons mentioned.
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U2 - 10.1002/14651858.CD012920.pub2
DO - 10.1002/14651858.CD012920.pub2
M3 - Review article
C2 - 34304394
AN - SCOPUS:85111326933
SN - 1465-1858
VL - 2021
JO - Cochrane Database of Systematic Reviews
JF - Cochrane Database of Systematic Reviews
IS - 7
M1 - CD012920
ER -