title: Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: a meta-analysis.
abstract: OBJECTIVE
  The optimal surgical strategy for acute type A aortic dissection (ATAAD) is still controversial because of the inconsistent or even conflicting results of proximal aortic repair (PR) versus extensive aortic repair (ER) on early and late prognostic outcomes. This meta-analysis pooled data from all available studies of PR versus ER to get a summarized conclusion.
  
  
  METHODS
  Studies were identified by searching the Medline, EMBASE and Cochrane databases. Early and late prognostic outcomes of interest were evaluated with meta-analysis. Fixed- or random-effect models were used according to the significance of heterogeneity. Robustness of pooled estimates and the source of heterogeneity were assessed via sensitivity analyses and meta-regression, respectively. Publication bias was evaluated by the funnel plot and Egger's test.
  
  
  RESULTS
  Nine studies with a total of 1872 patients were included for the meta-analysis. Pooled results indicated that, when compared with the ER procedure, PR was associated with lower early mortality [risk ratio (RR) = 0.69, 95% confidence interval (CI) 0.54-0.90, P = 0.005] but higher incidence of postoperative aortic events including reoperation of the distal aorta (RR = 3.14, 95% CI 1.74-5.67, P < 0.001). PR and ER demonstrated analogous prognosis on long-term mortality (HR = 1.02, 95% CI 0.51-2.06, P = 0.96) and the incidences of early postoperative renal failure (RR = 0.75, 95% CI 0.49-1.14, P = 0.17) and stroke (RR = 0.73, 95% CI 0.30-1.78, P = 0.50). All the pooled results were robust to sensitivity analysis. Heterogeneity was insignificant except for the meta-analysis of late mortality.
  
  
  CONCLUSIONS
  Performing a less aggressive initial surgical procedure of PR in ATAAD patients would have lower early mortality but elevated incidence rates of late aortic reintervention, when compared with ER. Other prognostic results of the two surgical strategies including long-term mortality were similar for both.
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China tmengweismmu@163.com.
authors.forename: Zhi-Yun
authors.initials: ZY
authors.lastname: Xu
authors.affiliation: Cardiovascular Therapeutic Centre, The 117 Hospital of the Chinese People's Liberation Army, Hangzhou, Zhejiang, China.
authors.forename: Xue-Yan
authors.initials: XY
authors.lastname: Ding
authors.affiliation: Department of Cardiothoracic Surgery, The 153 Hospital of the Chinese People's Liberation Army, Zhengzhou, Henan, China.
authors.forename: Shu-Wei
authors.initials: SW
authors.lastname: Wang
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Xue
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China tmengweismmu@163.com.
authors.forename: Meng-Wei
authors.initials: MW
authors.lastname: Tan
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Acute type A aortic dissection; Extensive aortic repair; Meta-analysis; Proximal aortic repair