A systematic review and meta-analysis of total endovascular versus hybrid repair for the treatment of thoracoabdominal aortic aneurysms.

Abstract

Although open repair has been the traditional mainstay therapy for thoracoabdominal aortic aneurysms (TAAAs), it remains a surgical challenge. Recently, hybrid repair (HR) and total endovascular repair (TEVR) have emerged as viable alternatives in treating TAAAs. Thus, we aimed to compare the primary outcomes of in-hospital/30-day mortality, as well as secondary outcomes of postoperative complications including spinal cord ischemia, bowel ischemia, long-term dialysis, myocardial infarction and lower limb ischemia for HR vs TEVR for the treatment of TAAAs. We postulated that TEVR was associated with lower in-hospital and 30-day mortality and postoperative complication rates as compared with HR. Four scientific databases were searched from inception to November 18, 2021. Meta-analyses were performed for the primary and secondary outcomes. This study was conducted in adherence to the PRISMA guidelines. The search yielded 3312 articles. After a two-stage selection process, five articles were included for final analysis. The in-hospital/30-day mortality rate for TEVR was significantly lower compared with HR (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.20-0.36; P< .00001). TEVR was also associated with reduced bowel ischemia (OR, 0.22; 95% CI, 0.14 -0.35; P< .00001) and long-term dialysis (OR, 0.22; 95% CI, 0.16-0.29; P< .00001). There was, however, no difference in the incidence of spinal cord ischemia (OR, 1.26; 95% CI, 0.74-2.14; P= .39), stroke (OR, 0.65; 95% CI, 0.10-4.20; P= .65), myocardial infarction (OR, 0.60; 95% CI, 0.17-2.05; P= .41), and lower limb ischemia (OR, 0.67; 95% CI, 0.29-1.55; P= .35). Most study outcomes had low heterogeneity. Findings were also robust to sensitivity analysis. Compared with the HR, TEVR of TAAAs were associated with lower in-hospital and 30-day mortality, bowel ischemia, and long-term dialysis.