Comparative effectiveness and safety of open triple-branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta-analysis

Background The optimal surgical intervention for Stanford type A aortic dissection is controversial. The aim of this trial sequential meta-analysis was to investigate the comparative effectiveness and safety of open triple-branched stent graft and stent elephant trunk implantation for total aortic arch reconstruction in Sandford type A aortic dissection. Methods PubMed, Embase, Cochrane library, Chinese Biomedical Literature database (CBM), and China National Knowledge Infrastructure (CNKI) were searched for retrieving relevant studies from inception to February 28, 2022. We evaluated 30-day mortality, procedure-related time including cardiopulmonary bypass (CPB), aortic cross-clamp (ACC), and selective cerebral perfusion (SCP), the incidence of postoperative complications including paralysis, cerebral embolism, and acute renal failure, intensive care unit (ICU) time, and medical expenditure. Statistical analysis was performed by RevMan 5.4 and trial sequential analysis (TSA) software. Results Six studies involving 260 dissection cases were included eventually. Total aortic arch reconstruction with open triple-branched stent graft was comparable to the stented elephant trunk implantation in 30-day mortality, incidence of postoperative complications, ICU time, and medical expenditure, but open triple-branched stent graft was related to shorter procedure-related time including CPB (mean difference [MD] = -46.11, 95% confidence interval [CI] = -67.24 to -24.98, p < .001), ACC (MD = -42.82, 95% CI = -66.74 to -18.90, p < .001), and SCP (MD = -17.88, 95% CI = -33.36 to -2.39, p = .02). TSA confirmed robustness of findings. Conclusions Our analysis suggested that total aortic arch reconstruction with open triple-branched stent graft may be an effective and simplified procedure than the stented elephant trunk implantation.