Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Abstract

Objective: One of the factors contributing to complications related to open repair of the aorta is the construction of a hand-sewn anastomosis. Aortic anastomotic devices (AADs), such as the intraluminal ringed graft (IRG), and the anastomotic stenting technique have been developed to perform a sutureless and less complicated anastomosis. This study performed a systematic review and meta-analysis of the literature reporting clinical use of AADs and aimed to assess, primarily, the effect of each device on 30-day overall and operation-related mortality and aortic cross-clamping time and, secondarily, the rate of successful two-sided application of the IRG device and the operation-related morbidity for each device.Methods: An electronic search was performed using MEDLINE, Scopus, ScienceDirect, and Cochrane Library by two independent authors. Our exclusion criteria included studies incorporating fewer than three patients and studies reporting results solely from animals or in vitro testing, results solely from end-to-side anastomosis, and results solely from endarterectomy procedures. The last search date was February 1, 2018.Results: A total of 41 studies were identified that reported outcomes for the use of three different device types: IRG, anastomotic stenting technique, and surgical staplers. The last two types were classified together as the non-IRG group. The meta-analysis included 27 studies with 50 cohorts incorporating 1260 patients. The median age of the incorporated patients was 61.4 years (range, 51-73 years), and 68.9% were male. The operations were performed for the treatment of acute aortic dissection in 82.3%. The pooled overall 30-day mortality rate varied by device type; IRG devices had a mean rate of all-cause mortality of 9.71%, whereas non-IRG devices were associated with a significantly (I 2 ¼ 15.78%; P for Cochrane Q test < .19) lower rate of death (1.47%). The pooled mean aortic cross-clamping time was 35.83 minutes. Metaregression showed that the performance of two-sided anastomosis with the IRG device significantly decreased the aortic cross-clamping time. However, a successful two-sided ringed anastomosis was performed in approximately half of the cases.Conclusions: Taking into account that the majority of operations were performed for the treatment of acute aortic dissection, AADs had a relatively low rate of 30-day mortality. Despite the observed heterogeneity in study protocols and the small sample size in the non-IRG group, the non-IRG group presented with the lowest 30-day mortality rate. Specific device-related complications between the different device types need further investigation.

Precision Medicine in Aortic Anastomosis: A Numerical and Experimental Study of a Novel Double-Sided Needle

“…Devices such as ringed grafts, stents, staplers, couplers, and adhesives [24][25][26][27][28][29][30][31][32][33] have been considered in an effort to improve aortic anastomosis, and their use under experimental conditions has been examined. Through an elaborate meta-analysis [14], our team assessed the efficacy of these experimental devices in comparison with hand sewn anastomosis for the outcomes of anastomosis time and point of anastomosis rupture. The study shows that experimental alternative anastomotic devices significantly decrease the time needed to perform the anastomosis, but they are inferior in terms of the tensile strength of the hand-sewn technique, which might be credited to its ability to be adapted to almost any tissue condition that may be encountered.…”

“…Several alternative methods have been suggested incorporating the use of ringed grafts, stents, staplers, couplers, or adhesives, however, none of them have successfully replaced the hand-sewn technique in everyday clinical practice. Previous research on the efficacy of such devices in end-to-end anastomosis of the aorta has shown that, although they offer a faster anastomosis and satisfactory short-term mortality rates, they are inferior in terms of tensile strength compared with the hand-sewn technique [14,15].…”