Abstract 13161: Efficacy of Thoracic Endovascular Aortic Repair versus Best Medical Therapy in Treatment of Type B Aortic Dissection: A Meta-Analysis

Abstract

Background and aim: Techniques in endovascular therapy have evolved offering a promising alternative to medical therapy alone in Type B aortic dissections (TBADs). The aim of this meta-analysis is to compare mortality and overall complications in thoracic endovascular aortic repair (TEVAR) with best medical therapy (BMT) in patients with TBADs. Methods: We included any randomized control trials, case controls, prospective or retrospective cohort and cross sectional studies that compared TEVAR versus BMT for the treatment of type B aortic dissection. Multiple electronic databases were searched to identify relevant articles including PubMed, Scopus, and Web of Science. Review Manager (RevMan) software, version 5.4 was used to perform the analysis. Results: A total of 1966 studies were screened with 32 studies included. Thirty-two cohort studies including 150836 patients (19512 TEVAR and 131324 BMT) were included. TEVAR was associated with a significantly lower 30-day mortality rate compared to BMT (RR= 0.79, CI= 0.63, 0.99, P = 0.04) notably in patients ≥ 65 years of age (RR=0.78, CI=0.64, 0.95, P=0.01). TEVAR group had a statistically significant prolonged length of hospital (MD= 3.42, CI= 1.69, 5.13, P = 0.0001), and ICU stay (MD= 3.18, CI= 1.48, 4.89, P = 0.0003) compared to BMT. BMT was associated with increased overall complications (RR= 1.50, CI= 1.20, 1.86, P = 0.0003) and stroke (RR= 1.52, CI= 1.29, 1.79, P < 0.00001). No statistically significant difference in late mortality (1, 3, and 5 year), intervention-related (acute renal failure, spinal cord ischemia, myocardial infarction, respiratory failure, and sepsis), was noted between both groups. Conclusion: In patients with TBAD, TEVAR was associated with a decreased risk of 30-day mortality rate and overall complications compared to BMT. More randomized control trials are needed to support our findings.