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

Overview

Journal Front Surg

Specialty General Surgery

Date 2022 May 20

PMID 35592122

Authors

Yang Yang

Xi-Hao Zhang

Zuo-Guan Chen

Yong-Peng Diao

Zhi-Yuan Wu

Yong-Jun Li

Affiliations

Soon will be listed here.

Abstract

Objective: To 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.

Method: A 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 -test and the categorical variables were compared using the χ-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.

Result: A 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%; = 0.014) and mortality (4.6 vs. 1.3%; = 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%; = 0.015). The procedure success rate (90.8 vs. 93.6%; = 0.329), the follow-up mortality (7.7 vs. 7.6%; = 1) and dissection-related late mortality (3.9 vs. 5.3%; = 0.603) showed no significant difference.

Conclusion: Our 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 Registration: PROSPERO, identifier: CRD42021247609.

Citing Articles

Type B Aortic Dissection Management: A Narrative Review of Guidelines and Systematic Reviews.

Ghimire S, Arghami A, Masood Shah A, Billoo M, Billoo R, Zarenezhad M Galen Med J. 2024; 12:e2967.

PMID: 39430041 PMC: 11491120. DOI: 10.31661/gmj.v12i.2967.

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

Zhao W, Yang Y, Wu Z, Chen Z, Diao Y, Lan Y Front Cardiovasc Med. 2023; 10:1189750.

PMID: 37502183 PMC: 10369003. DOI: 10.3389/fcvm.2023.1189750.

References

Riambau V, Bockler D, Brunkwall J, Cao P, Chiesa R, Coppi G . Editor's Choice - Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017; 53(1):4-52. DOI: 10.1016/j.ejvs.2016.06.005. View

Eggebrecht H, Nienaber C, Neuhauser M, Baumgart D, Kische S, Schmermund A . Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2005; 27(4):489-98. DOI: 10.1093/eurheartj/ehi493. View

Bavaria J, Brinkman W, Hughes G, Khoynezhad A, Szeto W, Azizzadeh A . Outcomes of Thoracic Endovascular Aortic Repair in Acute Type B Aortic Dissection: Results From the Valiant United States Investigational Device Exemption Study. Ann Thorac Surg. 2015; 100(3):802-8. DOI: 10.1016/j.athoracsur.2015.03.108. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Xie E, Yang F, Liu Y, Xue L, Fan R, Xie N . Timing and Outcome of Endovascular Repair for Uncomplicated Type B Aortic Dissection. Eur J Vasc Endovasc Surg. 2021; 61(5):788-797. DOI: 10.1016/j.ejvs.2021.02.026. View

Sterne J, Hernan M, Reeves B, Savovic J, Berkman N, Viswanathan M . ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355:i4919. PMC: 5062054. DOI: 10.1136/bmj.i4919. View

Wang G, Cambria R, Lombardi J, Azizzadeh A, White R, Abel D . Thirty-day outcomes from the Society for Vascular Surgery Vascular Quality Initiative thoracic endovascular aortic repair for type B dissection project. J Vasc Surg. 2019; 69(3):680-691. DOI: 10.1016/j.jvs.2018.06.203. View

Xiang D, Kan X, Liang H, Xiong B, Liang B, Wang L . Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection. J Thorac Cardiovasc Surg. 2020; 162(1):26-36.e1. DOI: 10.1016/j.jtcvs.2019.11.127. View

Torrent D, McFarland G, Wang G, Malas M, Pearce B, Aucoin V . Timing of thoracic endovascular aortic repair for uncomplicated acute type B aortic dissection and the association with complications. J Vasc Surg. 2020; 73(3):826-835. DOI: 10.1016/j.jvs.2020.05.073. View

10.

Desai N, Gottret J, Szeto W, McCarthy F, Moeller P, Menon R . Impact of timing on major complications after thoracic endovascular aortic repair for acute type B aortic dissection. J Thorac Cardiovasc Surg. 2014; 149(2 Suppl):S151-6. DOI: 10.1016/j.jtcvs.2014.10.105. View

11.

Hossack M, Patel S, Gambardella I, Neequaye S, Antoniou G, Torella F . Endovascular vs. Medical Management for Uncomplicated Acute and Sub-acute Type B Aortic Dissection: A Meta-analysis. Eur J Vasc Endovasc Surg. 2020; 59(5):794-807. DOI: 10.1016/j.ejvs.2019.08.003. View

12.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

13.

Qin Y, Wang F, Li T, Ding W, Deng G, Xie B . Endovascular Repair Compared With Medical Management of Patients With Uncomplicated Type B Acute Aortic Dissection. J Am Coll Cardiol. 2016; 67(24):2835-42. DOI: 10.1016/j.jacc.2016.03.578. View

14.

Eleshra A, Kolbel T, Panuccio G, Rohlffs F, Sebastian Debus E, Tsilimparis N . Endovascular Therapy for Nonischemic vs Ischemic Complicated Acute Type B Aortic Dissection. J Endovasc Ther. 2019; 27(1):145-152. DOI: 10.1177/1526602819888672. View

15.

Dake M, Kato N, Mitchell R, Semba C, Razavi M, Shimono T . Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999; 340(20):1546-52. DOI: 10.1056/NEJM199905203402004. View

16.

Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P, Alric P . Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg. 2014; 48(3):285-91. DOI: 10.1016/j.ejvs.2014.05.012. View

17.

Tadros R, Tang G, Barnes H, Mousavi I, Kovacic J, Faries P . Optimal Treatment of Uncomplicated Type B Aortic Dissection: JACC Review Topic of the Week. J Am Coll Cardiol. 2019; 74(11):1494-1504. DOI: 10.1016/j.jacc.2019.07.063. View

18.

Munshi B, Doyle B, Ritter J, Jansen S, Parker L, Riambau V . Surgical Decision Making in Uncomplicated Type B Aortic Dissection: A Survey of Australian/New Zealand and European Surgeons. Eur J Vasc Endovasc Surg. 2020; 60(2):194-200. DOI: 10.1016/j.ejvs.2020.04.005. View

19.

Cambria R, Conrad M, Matsumoto A, Fillinger M, Pochettino A, Carvalho S . Multicenter clinical trial of the conformable stent graft for the treatment of acute, complicated type B dissection. J Vasc Surg. 2015; 62(2):271-8. DOI: 10.1016/j.jvs.2015.03.026. View

20.

Nakajima K, Kato N, Chino S, Higashigawa T, Ouchi T, Kato H . Therapeutic window for obtaining favorable remodeling after thoracic endovascular aortic repair of type B aortic dissection. J Vasc Surg. 2021; 75(3):861-867. DOI: 10.1016/j.jvs.2021.09.043. View