Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Hanzhao , HOU Peng , CHEN Zhengxi , XIA Lin , ZHANG Liyun , YU Shiqiang , LIU Jincheng ,  DUAN Weixun

Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, 710032, P.R.China;

Corresponding author：

DUAN Weixun, Email: duanweixun@126.com

Keywords：

Retrograde type; Stanford type A; aortic dissection; interventional treatment with covered stent graft; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202005052

Video：

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Objective To evaluate the prognosis of interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma by single-arm meta-analysis.Methods Related studies on treating retrograde Stanford type A aortic dissection and intramural hematoma with covered stent graft were retrieved from the databases by computer, including PubMed, EMbase, The Cochrane Library, Wanfang Data, VIP, CNKI and CBM, from inception to January 2020. Literatures were screened by researchers step by step according to the predefined inclusion and exclusion criteria. Quality of the enrolled literatures was evaluated, and data were extracted from the included studies. Afterwards, single-arm meta-analysis was carried out by the R3.6.3 software.Results A total of 12 English and 5 Chinese studies were included, which were all case series, and the quality of all literatures was moderate evaluated by Newcastle-Ottawa Scale (NOS). After analyzing the clinical prognosis of 260 patients, the 30-day mortality was 6% (95%CI 0.04 to 0.11, P=0.97), the late mortality was 8% (95%CI 0.05 to 0.14, P=0.78), the incidence of endoleak was 21% (95%CI 0.16 to 0.29, P=0.06), the incidence of stroke was 5% (95%CI 0.03 to 0.09, P=0.99), the incidence of new aortic dissection was 7% (95%CI 0.04 to 0.11, P=0.96), the incidence of dissection progression was 10% (95%CI 0.07 to 0.16, P=0.24), and the absorption rate of intramural hematoma was 84% (95%CI 0.37 to 1.00, P<0.01).Conclusion Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma can obtain good early treatment results for some patients, and can be used as a safe and effective treatment for aged patient with high risk who cannot tolerate surgery. Endoleak, stroke and new aortic dissection are the early serious complications of this method.

Citation： ZHU Hanzhao, HOU Peng, CHEN Zhengxi, XIA Lin, ZHANG Liyun, YU Shiqiang, LIU Jincheng, DUAN Weixun. Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1037-1044. doi: 10.7507/1007-4848.202005052 Copy

1.	Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation, 2005, 112(24): 3802-3813.
2.	Vilacosta I, San Román JA. Acute aortic syndrome. Heart, 2001, 85(4): 365-368.
3.	Shimono T, Kato N, Tokui T, <italic>et al</italic>. Endovascular stent-graft repair for acute type A aortic dissection with an intimal tear in the descending aorta. J Thorac Cardiovasc Surg, 1998, 116(1): 171-173.
4.	郭伟, 盖鲁粤, 刘小平, 等. 主动脉夹层腔内修复术 178 例术后早期疗效分析. 中华外科杂志, 2005, 43(14): 921-925.
5.	常光其, 王深明, 李晓曦, 等. 裂口位于主动脉弓远端 Stanford A 型主动脉夹层的腔内修复. 中国实用外科杂志, 2007, 27(10): 824-826.
6.	刘仕强, 汪华, 陈旭, 等. 腔内隔绝术治疗破口位于左锁骨下动脉远端的 Stanford A 型主动脉夹层. 中国综合临床, 2014, 30(4): 411-413.
7.	朱健, 郗二平, 朱水波, 等. 腔内修复术治疗破口位于降主动脉合并逆撕性壁间血肿的主动脉夹层. 中华血管外科杂志, 2016, 1(2): 93-96.
8.	吴海卫, 孙磊, 李德闽, 等. 腔内修复术治疗原发性逆撕型 Stanford A 型主动脉夹层. 中华外科杂志, 2016, 54(10): 761-765.
9.	Kato N, Shimono T, Hirano T, <italic>et al</italic>. Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: the complication-specific approach. J Thorac Cardiovasc Surg, 2002, 124(2): 306-312.
10.	Kusagawa H, Shimono T, Ishida M, <italic>et al</italic>. Changes in false lumen after transluminal stent-graft placement in aortic dissections: six years’ experience. Circulation, 2005, 111(22): 2951-2957.
11.	Wang S, Chang G, Li X, <italic>et al</italic>. Endovascular treatment of arch and proximal thoracic aortic lesions. J Vasc Surg, 2008, 48(1): 64-68.
12.	Grimm M, Loewe C, Gottardi R, <italic>et al</italic>. Novel insights into the mechanisms and treatment of intramural hematoma affecting the entire thoracic aorta. Ann Thorac Surg, 2008, 86(2): 453-456.
13.	Monnin-Bares V, Thony F, Rodiere M, <italic>et al</italic>. Endovascular stent-graft management of aortic intramural hematomas. J Vasc Interv Radiol, 2009, 20(6): 713-721.
14.	Ye C, Chang G, Li S, <italic>et al</italic>. Endovascular stent-graft treatment for Stanford type A aortic dissection. Eur J Vasc Endovasc Surg, 2011, 42(6): 787-794.
15.	Shu C, Wang T, Li QM, <italic>et al</italic>. Thoracic endovascular aortic repair for retrograde type A aortic dissection with an entry tear in the descending aorta. J Vasc Interv Radiol, 2012, 23(4): 453-460.
16.	Zhang W, Dong ZH, Fu WG, <italic>et al</italic>. Experience and early outcome of treating retrograde type A dissection with primary entry tear in the descending thoracic aorta. Chin Med J (Engl), 2013, 126(17): 3385-3387.
17.	Nauta FJH, Kim JB, Patel HJ, <italic>et al</italic>. Early outcomes of acute retrograde dissection from the International Registry of Acute Aortic Dissection. Semin Thorac Cardiovasc Surg, 2017, 29(2): 150-159.
18.	Urbanski PP, Sodah A, Matveeva A, <italic>et al</italic>. Importance of accurately locating the entry site for endovascular treatment of retrograde type A acute aortic dissection. Interact Cardiovasc Thorac Surg, 2018, 26(5): 731-737.
19.	Chen YY, Yen HT, Wu CC, <italic>et al</italic>. Thoracic endovascular aortic repair for type A intramural hematoma and retrograde thrombosed type A aortic dissection: A single-center experience. Ann Vasc Surg, 2020, 65: 224-231.
20.	Higashigawa T, Kato N, Nakajima K, <italic>et al</italic>. Thoracic endovascular aortic repair for retrograde type A aortic dissection. J Vasc Surg, 2019, 69(6): 1685-1693.
21.	Kim JB, Choo SJ, Kim WK, <italic>et al</italic>. Outcomes of acute retrograde type A aortic dissection with an entry tear in descending aorta. Circulation, 2014, 130(11 Suppl 1): S39-S44.
22.	Pape LA, Awais M, Woznicki EM, <italic>et al</italic>. Presentation, diagnosis, and outcomes of acute aortic dissection: 17 year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
23.	Parikh N, Trimarchi S, Gleason TG, <italic>et al</italic>. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg, 2017, 153(4): S74-S79.
24.	Hagan PG, Nienaber CA, Isselbacher EM, <italic>et al</italic>. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
25.	Dell'Aquila AM, Pollari F, Fattouch K, <italic>et al</italic>. Early outcomes in re-do operation after acute type A aortic dissection: results from the multicenter REAAD database. Heart Vessels, 2017, 32(5): 566-573.
26.	Ghoreishi M, Sundt TM, Cameron DE, <italic>et al</italic>. Factors associated with acute stroke after type A aortic dissection repair: an analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg, 2020, 159(6): 2143-2154.
27.	Bashir M, Harky A, Shaw M, <italic>et al</italic>. Type A aortic dissection in patients over the age of seventy in the UK. J Card Surg, 2019, 34(12): 1439-1444.
28.	Dumfarth J, Kofler M, Stastny L, <italic>et al</italic>. Stroke after emergent surgery for acute type A aortic dissection: predictors, outcome and neurological recovery. Eur J Cardiothorac Surg, 2018, 53(5): 1013-1020.
29.	Charlton-Ouw KM, Sandhu HK, Leake SS, <italic>et al</italic>. New type A dissection after acute type B aortic dissection. J Vasc Surg, 2018, 67(1): 85-92.
30.	Yammine H, Briggs CS, Stanley GA, <italic>et al</italic>. Retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2019, 69(1): 24-33.
31.	Estrera AL, Sandhu HK, Leake SS, <italic>et al</italic>. Early and late outcomes of acute type A aortic dissection with intramural hematoma. J Thorac Cardiovasc Surg, 2015, 149(1): 137-142.

1. Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation, 2005, 112(24): 3802-3813.
2. Vilacosta I, San Román JA. Acute aortic syndrome. Heart, 2001, 85(4): 365-368.
3. Shimono T, Kato N, Tokui T, <italic>et al</italic>. Endovascular stent-graft repair for acute type A aortic dissection with an intimal tear in the descending aorta. J Thorac Cardiovasc Surg, 1998, 116(1): 171-173.
4. 郭伟, 盖鲁粤, 刘小平, 等. 主动脉夹层腔内修复术 178 例术后早期疗效分析. 中华外科杂志, 2005, 43(14): 921-925.
5. 常光其, 王深明, 李晓曦, 等. 裂口位于主动脉弓远端 Stanford A 型主动脉夹层的腔内修复. 中国实用外科杂志, 2007, 27(10): 824-826.
6. 刘仕强, 汪华, 陈旭, 等. 腔内隔绝术治疗破口位于左锁骨下动脉远端的 Stanford A 型主动脉夹层. 中国综合临床, 2014, 30(4): 411-413.
7. 朱健, 郗二平, 朱水波, 等. 腔内修复术治疗破口位于降主动脉合并逆撕性壁间血肿的主动脉夹层. 中华血管外科杂志, 2016, 1(2): 93-96.
8. 吴海卫, 孙磊, 李德闽, 等. 腔内修复术治疗原发性逆撕型 Stanford A 型主动脉夹层. 中华外科杂志, 2016, 54(10): 761-765.
9. Kato N, Shimono T, Hirano T, <italic>et al</italic>. Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: the complication-specific approach. J Thorac Cardiovasc Surg, 2002, 124(2): 306-312.
10. Kusagawa H, Shimono T, Ishida M, <italic>et al</italic>. Changes in false lumen after transluminal stent-graft placement in aortic dissections: six years’ experience. Circulation, 2005, 111(22): 2951-2957.
11. Wang S, Chang G, Li X, <italic>et al</italic>. Endovascular treatment of arch and proximal thoracic aortic lesions. J Vasc Surg, 2008, 48(1): 64-68.
12. Grimm M, Loewe C, Gottardi R, <italic>et al</italic>. Novel insights into the mechanisms and treatment of intramural hematoma affecting the entire thoracic aorta. Ann Thorac Surg, 2008, 86(2): 453-456.
13. Monnin-Bares V, Thony F, Rodiere M, <italic>et al</italic>. Endovascular stent-graft management of aortic intramural hematomas. J Vasc Interv Radiol, 2009, 20(6): 713-721.
14. Ye C, Chang G, Li S, <italic>et al</italic>. Endovascular stent-graft treatment for Stanford type A aortic dissection. Eur J Vasc Endovasc Surg, 2011, 42(6): 787-794.
15. Shu C, Wang T, Li QM, <italic>et al</italic>. Thoracic endovascular aortic repair for retrograde type A aortic dissection with an entry tear in the descending aorta. J Vasc Interv Radiol, 2012, 23(4): 453-460.
16. Zhang W, Dong ZH, Fu WG, <italic>et al</italic>. Experience and early outcome of treating retrograde type A dissection with primary entry tear in the descending thoracic aorta. Chin Med J (Engl), 2013, 126(17): 3385-3387.
17. Nauta FJH, Kim JB, Patel HJ, <italic>et al</italic>. Early outcomes of acute retrograde dissection from the International Registry of Acute Aortic Dissection. Semin Thorac Cardiovasc Surg, 2017, 29(2): 150-159.
18. Urbanski PP, Sodah A, Matveeva A, <italic>et al</italic>. Importance of accurately locating the entry site for endovascular treatment of retrograde type A acute aortic dissection. Interact Cardiovasc Thorac Surg, 2018, 26(5): 731-737.
19. Chen YY, Yen HT, Wu CC, <italic>et al</italic>. Thoracic endovascular aortic repair for type A intramural hematoma and retrograde thrombosed type A aortic dissection: A single-center experience. Ann Vasc Surg, 2020, 65: 224-231.
20. Higashigawa T, Kato N, Nakajima K, <italic>et al</italic>. Thoracic endovascular aortic repair for retrograde type A aortic dissection. J Vasc Surg, 2019, 69(6): 1685-1693.
21. Kim JB, Choo SJ, Kim WK, <italic>et al</italic>. Outcomes of acute retrograde type A aortic dissection with an entry tear in descending aorta. Circulation, 2014, 130(11 Suppl 1): S39-S44.
22. Pape LA, Awais M, Woznicki EM, <italic>et al</italic>. Presentation, diagnosis, and outcomes of acute aortic dissection: 17 year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
23. Parikh N, Trimarchi S, Gleason TG, <italic>et al</italic>. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg, 2017, 153(4): S74-S79.
24. Hagan PG, Nienaber CA, Isselbacher EM, <italic>et al</italic>. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
25. Dell'Aquila AM, Pollari F, Fattouch K, <italic>et al</italic>. Early outcomes in re-do operation after acute type A aortic dissection: results from the multicenter REAAD database. Heart Vessels, 2017, 32(5): 566-573.
26. Ghoreishi M, Sundt TM, Cameron DE, <italic>et al</italic>. Factors associated with acute stroke after type A aortic dissection repair: an analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg, 2020, 159(6): 2143-2154.
27. Bashir M, Harky A, Shaw M, <italic>et al</italic>. Type A aortic dissection in patients over the age of seventy in the UK. J Card Surg, 2019, 34(12): 1439-1444.
28. Dumfarth J, Kofler M, Stastny L, <italic>et al</italic>. Stroke after emergent surgery for acute type A aortic dissection: predictors, outcome and neurological recovery. Eur J Cardiothorac Surg, 2018, 53(5): 1013-1020.
29. Charlton-Ouw KM, Sandhu HK, Leake SS, <italic>et al</italic>. New type A dissection after acute type B aortic dissection. J Vasc Surg, 2018, 67(1): 85-92.
30. Yammine H, Briggs CS, Stanley GA, <italic>et al</italic>. Retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2019, 69(1): 24-33.
31. Estrera AL, Sandhu HK, Leake SS, <italic>et al</italic>. Early and late outcomes of acute type A aortic dissection with intramural hematoma. J Thorac Cardiovasc Surg, 2015, 149(1): 137-142.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma: A systematic review and meta-analysis

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