Spinal cord iniury after open and endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms: A meta-analysis
Spinal cord iniury after open and endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms: A meta-analysis
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DOI：
10.1016/j.jtcvs.2020.04.126
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发表时间：
2022-01-13
影响因子：
6
通讯作者：
Girardi, Leonard N.
中科院分区：
文献类型：
--
作者：
Gaudino, Mario;Khan, Faiza M.;Girardi, Leonard N.
目的：一个包容性的当代分析脊髓损伤（SCI）的发生率在接受动脉瘤修复和并发症的相关因素尚未performed.Methods：经过系统的文献检索，研究从2008年至2018年的胸降主动脉瘤（DTA）和胸腹主动脉瘤（TAAA）修复合并在一个荟萃分析使用通用逆方差法进行。主要结局为永久性SCI。次要结局为暂时性SCI、手术死亡率、长期死亡率、术后卒中和脑脊液（CSF）引流相关并发症。永久性SCI的合并率为4.5%（95%置信区间[CI]，3.8-5.4）;百分之三点五DTA和7.6%（95% CI，1.8-6.7）（96% CI，6.2-9.3）（亚组P = 0.02），开放性修复为5.7%（95% CI，4.3-7.5），腔内修复为3.9%（95% CI，3.1-4.8）（亚组P = 0.03）。Crawford I、II、III、IV和V段动脉瘤的发生率分别为4.0%（95% CI，3.0-5.0）、15.0%（95% CI，10.0-22.0）、7.0%（95% CI，6.0-9.0）、2.0%（95% CI，2.0-4.0）和7.0%（95% CI，2.0-23.0）（亚组P
Objective: An inclusive contemporary analysis of spinal cord injury (SCI) rates in patients undergoing aneurysm repair and the factors associated with complications has not been performed.Methods: Following a systematic literature search, studies from 2008 to 2018 on repair of descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA) were pooled in a meta-analysis performed using the generic inverse variance method. The primary outcome was permanent SCI. Secondary outcomes were temporary SCI, operative mortality, long-term mortality, postoperative stroke, and cerebrospinal fluid (CSF) drain-related complications.Results: One-hundred sixty-nine studies (22,634 patients) were included. The pooled rate of permanent SCI was 4.5% (95% confidence interval [CI], 3.8-5.4); 3.5% (95% CI, 1.8-6.7) for DTA and 7.6% (96% CI, 6.2-9.3) for TAAA repair (P for subgroups = .02), 5.7% (95% CI, 4.3-7.5) for open repair and 3.9% (95% CI, 3.1-4.8) for endovascular repair (P for subgroups = .03). Rates for Crawford extents I,II,III, IV, and V aneurysms were 4.0% (95% CI, 3.0-5.0),15.0% (95% CI, 10.0-22.0), 7.o% (95% CI, 6.0-9.0), 2.0% (95% CI, 2.0-4.0), and 7.0% (95% CI, 2.0-23.0) respectively (P for subgroups