External wrapping of the ascending aorta versus ascending aorta replacement: Systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared external wrapping with ascending aorta replacement for moderately dilated ascending aortas. Eight comparative studies included 851 patients, with mean follow-up of 3.9 years (95% confidence interval, 1.8-8.4 years). Thirty-day mortality did not differ significantly between procedures (odds ratio, 0.61; 95% confidence interval, 0.24-1.56), nor did midterm mortality. Wrapping was associated with shorter cardiopulmonary bypass and crossclamp times and shorter intensive care and hospital stays. The analysis did not establish clinical equivalence, and replacement remains the gold standard.

Key findings

• Thirty-day mortality was not significantly different with wrapping versus replacement (odds ratio, 0.61; 95% confidence interval, 0.24-1.56).
• Midterm mortality was similar between groups (incidence rate ratio, 0.97; 95% confidence interval, 0.57-1.66).
• Wrapping was associated with 42.4 minutes shorter cardiopulmonary bypass time and 30.6 minutes shorter crossclamp time.
• Wrapping was associated with 22.6 hours shorter intensive care stay and 2.4 days shorter hospital stay.

Why it matters

The findings suggest that external wrapping may be associated with lower operative resource use and shorter postoperative stays, without a detected mortality difference in the included studies. However, absence of a statistically significant difference does not demonstrate equivalent safety or durability. These results help frame the trade-offs between a less extensive procedure and the established replacement approach, while underscoring uncertainty about longer-term outcomes.

What to keep in mind

The included studies were retrospective, with limited follow-up, heterogeneous patient selection, and inconsistent outcome reporting; these factors limit applicability and do not establish clinical equivalence.