968 Optimal Timing for Endovascular Aortic Repair in Patients with Blunt Thoracic Aortic Injury: A Systematic Review and Meta-Analysis

Abstract

Abstract Aim The optimal timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injuries (BTAI) remains a topic of debate. We performed a systematic review and meta-analysis to compare early versus delayed TEVAR in BTAI. Method We systematically searched PubMed, Embase, Cochrane Central and Clinicaltrials.gov in up to October 2023 to include studies comparing TEVAR performed <24 hours versus >24 hours in BTAI. Safety outcomes were pooled as odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Subgroup analysis was performed with propensity-score matching or multivariate-analysis studies. Statistical analysis was performed with RevMan 5.4.1 and R software. The protocol was registered in PROSPERO (ID:CRD42023427392). Results Nine studies with 4163 patients were included, of whom 30.2%(n=1257) underwent delayed TEVAR. Mortality was significantly lower in the delayed TEVAR group (OR 0.44; 95% CI 0.32–0.59; p<0.001; I²=0%), with consistent results when restricted to multivariate studies (p<0.001). Although delayed TEVAR resulted in significantly lower rates of sepsis (OR 0.37; 95% CI 0.18–0.78; p=0.009; I²=67%), it was also associated with increased durations of hospital stay (MD 3.28; 95% CI 1.58–4.98; p<0.001), ICU stay (MD 2.53; 95% CI 0.92–4.14; p=0.002), AKI (OR 1.71; 95% CI 1.04–2.83; p=0.04), and ventilator use (MD 1.20; 95% CI 0.51-1.89; p<0.001). Conclusions Our findings show that delayed TEVAR is associated with lower mortality and sepsis, but also an increased risk of in-hospital complications. This may guide future prospective studies to investigate optimal timings according to grades of injury and associated complications.