title: Hybrid Versus Conventional Treatment of Acute Type A Aortic Dissection.
abstract: BACKGROUND
  To determine whether the hybrid approach to acute type A aortic dissection results in improved outcomes in terms of mortality, neurologic complications, need for distal aortic reintervention, and false lumen thrombosis compared with the conventional approach.
  
  
  METHODS
  Data from comparative studies of hybrid versus conventional treatment of acute type A aortic dissection were combined through meta-analysis. Pooled odd ratios were calculated using random effects models.
  
  
  RESULTS
  Seven comparative studies including 967 patients were identified; of these, 503 underwent conventional proximal aortic repair and 429 extensive distal aortic repair including a stented elephant trunk technique. Between the two groups there was no significant difference in operative mortality (p = 0.96), permanent neurologic deficit (p = 0.95), and late mortality (p = 0.59). Distal aortic repair showed a higher rate of false lumen thrombosis of the thoracic aorta (odd ratio 11.16; p < 0.001) and a reduced risk of distal reintervention (odd ratio 0.37; p = 0.01). In sub-group analysis, frozen elephant trunk procedure showed a lower rate of distal aortic reintervention and a higher rate of false lumen thrombosis than antegrade/retrograde stent deployment techniques (p = 0.008 and <0.001, respectively).
  
  
  CONCLUSIONS
  Distal aortic repair may reduce the risk of distal reintervention and increase the rate of false lumen thrombosis without significant increase in operative mortality and permanent neurologic deficit; however, no benefit with respect to late mortality was found. The frozen elephant trunk may reduce the risk of distal aortic reintervention and may increase the false lumen thrombosis of the thoracic aorta in comparison with antegrade/retrograde stent deployment procedures.
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Settepani
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
authors.forename: Antioco
authors.initials: A
authors.lastname: Cappai
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Basciu
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barbone
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Citterio
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Ornaghi
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarelli
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D016206:Databases, Bibliographic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality