Background: The treatment of complex thoracic aorta pathologies remains
a challenge for cardiovascular surgeons. After introducing Frozen
Elephant Trunk (FET), a significant evolution of surgical techniques has
been achieved. The present meta-analysis aimed to assess the efficacy of
FET in acute type A aortic dissection (ATAAD) and the effect of
circulatory arrest time on post-operative neurologic outcomes. Methods:
A standard Preferred Reporting Items for Systematic Reviews and
Meta-Analyses search was conducted for all observational studies of
patients diagnosed with ATAAD undergoing total arch replacement with FET
reporting in-hospital mortality, bleeding, and neurological outcomes. A
random-effect meta-analysis was performed using STATA software
(StataCorp, TX, USA). Results: Thirty-five studies were eligible for the
present meta-analysis, including 3211 patients with ATAAD who underwent
total arch replacement with FET. The pooled estimate for in-hospital
mortality, postoperative stroke, and spinal cord injury were 7% (95%
CI 5 – 9; I2 = 68.65%), 5% (95% CI 4 – 7; I2 = 63.93%), and 3%
(95% CI 2 – 4; I2 = 19.56%), respectively. Univariate meta-regression
revealed that with increasing the duration of hypothermic circulatory
arrest time, the effect sizes for postoperative stroke and SCI enhances.
Conclusions: It seems that employing the FET procedure for acute type A
dissection is associated with acceptable neurologic outcomes and a
similar mortality rate comparing with other aorta pathologies. Besides,
increasing hypothermic circulation arrest time appears to be a
significant predictor of adverse neurologic outcomes after FET.
Which cannulation (axillary cannulation or femoral cannulation) is better for acute type A aortic dissection repair? A meta-analysis of nine clinical studies
