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Correlation of Coagulopathy and Frozen Elephant Trunk Use in Aortic Arch Surgery: A Systematic Review and Meta-analysis
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  • Mohamad Bashir,
  • Hadi Abo Aljadayel,
  • Mostafa Mousavizadeh,
  • Mahdi Daliri,
  • Yousef Rezaei,
  • Cian Tan,
  • Mohammed Idhrees,
  • Saeid Hosseini
Mohamad Bashir
Iran University of Medical Sciences
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Hadi Abo Aljadayel
Iran University of Medical Sciences
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Mostafa Mousavizadeh
Iran University of Medical Sciences
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Mahdi Daliri
Iran University of Medical Sciences
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Yousef Rezaei
Iran University of Medical Sciences
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Cian Tan
Queen Mary University of London Barts and The London School of Medicine and Dentistry
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Mohammed Idhrees
SRM Institutes for Medical Science Vadapalani
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Saeid Hosseini
Iran University of Medical Sciences
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Abstract

Background: The advent of Frozen elephant trunk (FET) for reconstruction of elective and non-elective aortic arch surgery has augmented the treatment of complex aortic pathologies in a single-stage operation. To date, no studies have been focused on the prevalence and predictors of coagulopathy potentiated by FET procedure. Methods: In a systematic review, we searched databases up to June 2020 for studies reporting coagulopathy complications after FET procedure. A proportional meta-analysis was carried out using STATA software (StataCorp, TX, USA). Results: In total, 46 studies including 6313 patients were eligible. The pooled estimation of reoperation for postoperative bleeding was 7% (95% confidence interval [CI] 5 to 8; I2 = 84.73%; reported by 39 studies including 4796 patients). The mean volume of transfused packed blood cells and fresh frozen plasma was 1677 ml (95% CI 1066.4-2287.6) and 1016.5 ml (95% CI 450.7-1582.3). The subgroup by stent type showed a decrease in the heterogeneity (I2 = 0.01%, I2 = 53.95%, I2 = 0.01%, and I2 = 54.41% for Thoraflex® Hybrid, E-vita®, Frozenix®, and Cronus®, respectively). The subgroup by chronicity of operation resulted in less heterogeneity among patients undergoing elective compared to non-elective operation (I2 = 29.22% versus I2 = 80.56% in non-elective). Meta-regression analysis showed that age and male gender significantly impacted on the reoperation for postoperative bleeding. Conclusions: The FET procedure for arch replacement is associated with coagulopathy and the transfusion of blood products. Male, age, and selective choice of FET use were identified as heterogeneity sources of reoperation for postoperative bleeding.

Peer review status:ACCEPTED

05 Sep 2021Submitted to Journal of Cardiac Surgery
08 Sep 2021Assigned to Editor
08 Sep 2021Submission Checks Completed
08 Sep 2021Reviewer(s) Assigned
14 Sep 2021Review(s) Completed, Editorial Evaluation Pending
14 Sep 2021Editorial Decision: Accept