Acute or Subacute, the Optimal Timing for Uncomplicated Type B Aortic Dissection: A Systematic Review and Meta-Analysis

Abstract

ObjectiveTo evaluate the optimal timing (acute or subacute) of thoracic endovascular aortic repair (TEVAR) for uncomplicated B aortic dissection (uTBAD) through a systematic review and meta-analysis.MethodA comprehensive literature search was undertaken across three major databases (EMBASE/Medline, PubMed, and Cochrane Library) and was assessed until November 2021 to identify studies reporting the outcomes of TEVAR utilized to treat patients with uTBAD. The continuous variables were compared between the two groups using t-test and the categorical variables were compared using the χ2-test. A meta-analysis was used to produce pooled odds ratios for early and follow-up outcomes. The random effects models were applied. A statistical analysis was performed using R software v.4.1.ResultA comprehensive literature search found 490 citations published within the predetermined time span of the analysis. Three studies including 1,193 patients (acute group 718, subacute group 475) were finally included for downstream meta-analysis. An acute uTBAD group presented with higher rates both in 30-day complications (20.5 vs. 13.7%; p = 0.014) and mortality (4.6 vs. 1.3%; p = 0.004) than subacute group. The respiratory complications were significantly higher in the acute group than in the subacute group (10.8 vs. 5.0%; p = 0.015). The procedure success rate (90.8 vs. 93.6%; p = 0.329), the follow-up mortality (7.7 vs. 7.6%; p = 1) and dissection-related late mortality (3.9 vs. 5.3%; p = 0.603) showed no significant difference.ConclusionOur meta-analysis suggested that despite significantly higher 30-day complications and 30-day mortality in the acute uTBAD group, there was no significant difference in the follow-up mortality between the two groups.Systematic Review RegistrationPROSPERO, identifier: CRD42021247609.

Endovascular repair of acute vs. subacute uncomplicated type B aortic dissection: a systematic review and meta-analysis

“…By conducted the meta-analysis of published data on long-term survival outcomes, we found no significant difference in long-term mortality between the two group but with significant heterogeneity. This is consistent with the conclusions of published meta-analysis ( 24 ). Through data analysis, we suggest that this heterogeneity may be caused by differences in follow-up time.…”

“…So far, studies on the timing of TEVAR are varied. Apart from a study conducted by our group in 2022, no other relevant meta-analyses have been published ( 24 ). Due to the limited number of included studies, the results of the previous meta-analysis were not significant and the evidence level was low.…”

“…A search of PubMed, EMBASE, web of science and Cochrane Library was interrogated to identify Electronic bibliographic studies updated to January 2023. Our search string was as previously: (“stent” OR “endovascular”) AND (“DeBakey III” OR “type B”) AND “uncomplicated” AND “aortic dissection” AND (“timing” OR “phase” OR “period”) ( 24 ). Only English language articles were considered due to limited funding for translation and We also searched the reference lists of included studies and reviews for relevant reports.…”