Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms
Appendices
Appendix 1. Glossary of terms
A
Antegrade cerebral perfusion (ACP) is a cardiopulmonary bypass technique that uses cannulation procedures to supply blood to only the brain during aortic arch surgical repair.
Aortic arch debranching involves rerouting (debranching) of the aortic arch vessels from the aortic arch using a bypass graft and then an endograft stent is placed to treat the aortic aneurysm. This procedure does not require cardiopulmonary bypass.
C
Cardiopulmonary bypass often referred to as the heart‐lung machine, is a technique that temporally takes over the function of the heart and lungs during aortic arch surgical repair. It maintains blood flow circulation and oxygen content within the body.
Comorbidity is defined as a medical condition that co‐occurs with another medical condition.
E
Endovascular repair is a less invasive technique to open surgical repair and hybrid repair. It involves a small incision in the groin. The catheter is used to guide and deliver the stent graft into the aortic arch aneurysm. The device is deployed in to the aorta to seal the aortic aneurysm from the blood flow.
H
Hemi‐arch replacement involves repair or replacement of the proximal arch beyond the level of the brachiocephalic artery although it does not involve the arch vessels.
Hypothermic circulatory arrest temporarily stops blood flow under extremely cold body temperature to safely allow repair of the aorta for up to 40 minutes.
R
Retrograde cerebral perfusion (RCP) is a neuroprotective technique carried out through the superior vena cava cannula. It decreases the risk of brain injury by maintaining blood flow to the brain, providing back washing of toxic metabolites and possible blood clots and or air bubbles and reduces blood cell microaggregation.
References used for glossary:
Ergin 1994; Fraser 2008; Griepp 2013; Hongku 2016; Poon 2016.
Appendix 2. CENTRAL search strategy
| #1 | MESH DESCRIPTOR Aortic Aneurysm |
| #2 | MESH DESCRIPTOR Aortic Aneurysm, Thoracic EXPLODE ALL TREES |
| #3 | MESH DESCRIPTOR Aorta, Thoracic WITH QUALIFIERS SU |
| #4 | (aortic arch):TI,AB,KY |
| #5 | TAA:TI,AB,KY |
| #6 | #1 OR #2 OR #3 OR #4 OR #5 |
| #7 | hybrid:TI,AB,KY |
| #8 | debranch*:TI,AB,KY |
| #9 | supraaortic:TI,AB,KY |
| #10 | rerouting:TI,AB,KY |
| #11 | MESH DESCRIPTOR Endovascular Procedures EXPLODE ALL TREES |
| #12 | MESH DESCRIPTOR Stents EXPLODE ALL TREES |
| #13 | MESH DESCRIPTOR Blood Vessel Prosthesis EXPLODE ALL TREES |
| #14 | MESH DESCRIPTOR Blood Vessel Prosthesis Implantation EXPLODE ALL TREES |
| #15 | endovasc*:TI,AB,KY |
| #16 | endostent*:TI,AB,KY |
| #17 | endoluminal:TI,AB,KY |
| #18 | endoprosthe*:TI,AB,KY |
| #19 | (graft or endograft*):TI,AB,KY |
| #20 | percutaneous*:TI,AB,KY |
| #21 | stent*:TI,AB,KY |
| #22 | TEVAR:TI,AB,KY |
| #23 | branched:TI,AB,KY |
| #24 | fenestrated:TI,AB,KY |
| #25 | (elephant trunk):TI,AB,KY |
| #26 | (landing zone):TI,AB,KY |
| #27 | #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 |
| #28 | #6 AND #27 |
| Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms | ||||||
| Patient or population: patients with a diagnosis of thoracic aortic arch aneurysms Settings: hospital, elective and emergency Intervention: hybrid repair Comparison: conventional open surgical repair | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Open surgical repair | Hybrid repair | |||||
| Aneurysm related mortality 30 days Follow up: median N | Study population | HR N (N to N) | N | ⊕⊝⊝⊝ ⊕⊕⊝⊝ ⊕⊕⊕⊝ ⊕⊕⊕⊕ | ||
| N per 1000 (N to N) | N per 1000 (N to N) | |||||
| Aneurysm related mortality 12 months Follow up: median N | Study population | HR N (N to N) | N | ⊕⊝⊝⊝ ⊕⊕⊝⊝ ⊕⊕⊕⊝ ⊕⊕⊕⊕ | ||
| N per 1000 (N to N) | N per 1000 (N to N) | |||||
| Neurological deficit1 Follow up: median N | Study population | RR N (N to N) | N (N to N) | ⊕⊝⊝⊝ ⊕⊕⊝⊝ ⊕⊕⊕⊝ ⊕⊕⊕⊕ | ||
| N per 1000 | N per 1000 (N to N) | |||||
| Cardiovascular event2 Follow up: median N | Study population | RR N (N to N) | N (N to N) | ⊕⊝⊝⊝ ⊕⊕⊝⊝ ⊕⊕⊕⊝ ⊕⊕⊕⊕ | ||
| N per 1000 (N to N) | N per 1000 (N to N) | |||||
| Respiratory compromise Follow up: median N | Study population | RR N (N to N) | N (N to N) | ⊕⊝⊝⊝ ⊕⊕⊝⊝ ⊕⊕⊕⊝ ⊕⊕⊕⊕ | ||
| N per 1000 (N to N) | N per 1000 (N to N) | |||||
| Graft patency Follow up: median N | Study population | RR N (N to N) | N (N to N) | ⊕⊝⊝⊝ ⊕⊕⊝⊝ ⊕⊕⊕⊝ ⊕⊕⊕⊕ | ||
| N per 1000 (N to N) | N per 1000 (N to N) | |||||
| Reintervention Follow up: median N | Study population | RR N (N to N) | N (N to N) | ⊕⊝⊝⊝ ⊕⊕⊝⊝ ⊕⊕⊕⊝ ⊕⊕⊕⊕ | ||
| N per 1000 (N to N) | N per 1000 (N to N) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; HR: Hazard ratio; N: Number; RR: Risk ratio; OSR: open surgical repair | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 A neurological deficit event includes stroke or paraplegia | ||||||
