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

WenXin Zhao; Yang Yang; ZhiYuan Wu; ZuoGuan Chen; YongPeng Diao; Yong Lan; YongJun Li

doi:10.3389/fcvm.2023.1189750

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

Front Cardiovasc Med. 2023 Jul 12:10:1189750. doi: 10.3389/fcvm.2023.1189750. eCollection 2023.

Authors

WenXin Zhao^{1

2}, Yang Yang^{1

2}, ZhiYuan Wu¹, ZuoGuan Chen¹, YongPeng Diao¹, Yong Lan^{1

2}, YongJun Li^{1

2}

Affiliations

¹ Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
² Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

Abstract

Objective: This study aimed to conduct a meta-analysis evaluating the optimal timing for endovascular repair of acute versus subacute uncomplicated Type B Aortic Dissection.

Method: PubMed, EMBASE, web of science and Cochrane Library was interrogated to identify Electronic bibliographic studies updated to January 2023 to collect studies compared the clinical outcomes of endovascular repair for Acute Versus Subacute Uncomplicated Type B Aortic Dissection. Data were aggregated as pooled odds ratios (OR) using the fixed or random effects models according to the significance of heterogeneity, Pooled odds ratios (OR) were calculated by RevMan 5.3 and applied with fixed or random-effect models.

Result: A comprehensive literature search found 322 citations published and finally among them 6 studies containing 3,769 patients (acute group 2,642, subacute group 1,127) were included in review. There is an increased risk of 30-day complications (OR = 1.51,95%CI,1.26-1.81) 30-day mortality (OR = 2.39,95%CI, 1.55-3.67) and 1-year mortality (OR = 1.71,95%CI,1.27-2.30) for an acute uTBAD group compared to subacute ones. Similarly, reintervention was more likely in the acute group than in the subacute group (OR = 1.42,95%CI,1.05-1.91). However, no significant differences were found in long-term mortality.

Conclusion: This meta-analysis confirmed that there was no significant difference in the long-term prognosis between the acute and subacute phases in the timing of surgery. However, considering the high incidence of complications, high re-intervention rate and one-year mortality probably caused by high intima fragility in the acute phase, endovascular repair at subacute phase appears to favorably compare with acute strategy. But future studies with adequate patient numbers and longer-term follow-up are necessary to further verify the study conclusion.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021247609, identifier PROSPERO CRD42021247609.

Keywords: TEVAR; acute; endovascular repair; subacute; uncomplicated type B aortic dissection.

Publication types

Review

Grants and funding

YJL is supported by the National Key Research and Development Project of China (No.2020YFC2008003) and CAMS Innovation Fund for Medical Sciences (CIFMS. 2021-I2M-1-050). ZYW is supported by National High Level Hospital Clinical Research Funding (No. BJ-2021-205).