Management of Acute Type B Thoracic Aortic Dissection through Open or Endovascular Repair: A Meta-Analysis Qualitative and Quantitative Analyses

Document Type : Original Article

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The Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University

Abstract

Background: Acute aortic dissection is defined as dissec-tion occurring within 2 weeks of onset of pain. Sub acute and chronic dissections occur between 2 and 6 weeks, and more than 6 weeks from the onset of pain, respectively. Aim of Study: To compare TEVAR and open surgical repair across a comprehensive range of outcomes reported from stud-ies. The primary outcomes of the studies include early mortali-ty, midterm or long-term survival rate, the secondary outcomes include early and late complications compared in both methods. Patients and Methods: This systemic review and meta-anal-ysis considered randomized controlled trials and retrospective or prospective observational studies, evaluating endovascular repair, open surgery, and those comparing the 2 techniques for acute type “B” aortic dissection treatment. Results: The total number of patients included in the analy-sis was 18339 patients; among them, 11677 patients underwent open repair and 6662 patients had endovascular repair of an acute type B aortic dissection. Patients who underwent open repair were younger than those underwent endovascular repair (60.76±5.77 years vs 65.18±6.16 years, respectively). All the studies reported the percentage of male’s attendance over the half of included patients. Conclusion: In our meta-analysis of over 18,000 patients, TEVAR (n=6662) had higher rates of comorbidities compared to open repair (n=11677) for acute type B aortic dissection. There were no differences in paraplegia, stroke, neurologic or vascular complications. TEVAR had less renal failure but similar cardiovascular complications. Intensive care stay was shorter with TEVAR. In-hospital and 1-year mortality were sig-nificantly lower with TEVAR but 5-year mortality was similar between groups. In conclusion, despite sicker patients, TEVAR achieved decreased intensive care duration, early mortality ben-efit through 1 year, and less renal failure, with similar longer-term survival and neurological, vascular and cardiovascular complications compared to open repair for type B dissection. The early outcomes favor TEVAR while longer-term results are comparable to open surgery.

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