Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis

Abstract

Background The treatment of complex thoracic aorta pathologies remains a challenge for cardiovascular surgeons. After introducing Frozen Elephant Trunk (FET), a significant evolution of surgical techniques has been achieved. The present meta‐analysis aimed to assess the efficacy of FET in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on post‐operative neurologic outcomes. Methods A standard Preferred Reporting Items for Systematic Reviews and Meta‐Analyses search was conducted for all observational studies of patients diagnosed with ATAAD undergoing total arch replacement with FET reporting in‐hospital mortality, bleeding, and neurological outcomes. A random‐effect meta‐analysis was performed using STATA software (StataCorp, TX, USA). Results Thirty‐five studies were eligible for the present meta‐analysis, including 3211 patients with ATAAD who underwent total arch replacement with FET. The pooled estimate for in‐hospital mortality, postoperative stroke, and spinal cord injury were 7% (95% CI 5 – 9; I2 = 68.65%), 5% (95% CI 4 – 7; I2 = 63.93%), and 3% (95% CI 2 – 4; I2 = 19.56%), respectively. Univariate meta‐regression revealed that with increasing the duration of hypothermic circulatory arrest time, the effect sizes for postoperative stroke and SCI enhances. Conclusions It seems that employing the FET procedure for acute type A dissection is associated with acceptable neurologic outcomes and a similar mortality rate comparing with other aorta pathologies. Besides, increasing hypothermic circulation arrest time appears to be a significant predictor of adverse neurologic outcomes after FET.

A Novel Sutureless Integrated Stented (SIS) Graft Prosthesis for Type A Aortic Dissection: A Pilot Study for a Prospective, Multicenter Clinical Trial

“…Pacini and Leontyev both failed to identify a correlation between the distal landing zone level and the prevalence of spinal cord injury in their research ( 29 , 49 , 50 ). Mousavizadeh demonstrated statistically significant relationships between CA time and the development of postoperative stroke and spinal cord injury ( 51 ). Detailed results showed that as the CA time increased, the effect sizes for postoperative stroke and spinal cord injury were enhanced.…”

Methodological quality of a meta‐analysis precedes its clinical significance

“…Dear Editor, We read the recent publication entitled "Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta-analysis" by Dr. Mousavizadeh et al 1 with great interest. In this study, they aimed to assess the efficacy of frozen elephant trunk (FET) in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on postoperative neurologic outcomes.…”

Neurologic outcome after aortic arch repair with frozen elephant trunk: The pivotal role of hypothermic circulatory arrest time

“…1 Dr. Tan's comments on our article, "Hypothermic circulatory arrest time affects neurologic outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta-analysis" published in the Journal of Cardiac Surgery. 2 Frozen Elephant Trunk (FET) was described primarily to treat arch and proximal descending aorta pathologies in a single-stage approach in the early 2000s 3 and subsequently, evolved with great endeavors through recent years. The most important advantage of FET is to provide "hybrid" alternative treatment for complex pathologies which required two morbid surgeries, formerly.…”