Objective

Acute type A aortic dissection is a surgical emergency associated with high mortality and morbidity. Appropriate management is crucial for achieving satisfactory outcomes but the optimal surgical approach remained controversial. The present systematic review and meta-analysis sought to access cumulative data from comparative studies between hemiarch and total aortic arch replacement in patients with acute type A aortic dissection.

Methods

An electronic search was performed on 6 databases to identify comparative studies on hemiarch versus total aortic arch replacement. The primary outcome was in-hospital mortality. A number of perioperative findings were identified as secondary outcomes, including new-onset stroke, neurological dysfunction and renal failure. Meta-analysis on the effect size, t-test, i2 heterogeneity test, and forest plot assessing the relative impact of each study was performed.

Results

11 clinical studies were included. 1255 patients were treated with hemiarch replacement (HA) and 615 with total arch repair (TA), with a total of 1860 patients. The in-hospital mortality did not differ significantly between HA and TA (RR=0.80; p=0.14). The incidence of post-operative renal dialysis was significantly higher in TA (RR=0.72, p=0.02), with significantly longer operative times. No significant differences were detected in stroke, neurological events and reapportion for bleeding.

Conclusion

Based on current literature, this meta-analysis showed that hemiarch replacement can be performed safely with satisfactory early outcomes and is associated with lower post-operative renal dialysis. However, long terms follow up data and survival data from randomized controlled trials are required to assess the optimal surgical approach for acute type A dissection.