Long term outcomes of thoracic endovascular repair versus optimal medical therapy for uncomplicated Stanford type B aortic dissection: a systematic review and meta-analysis.

Introduction: The aim of this article is to compare the long-term efficacy of Thoracic Endovascular Aortic Repair (TEVAR) versus Optimal Medical Therapy (OMT) in reducing mortality among adult patients with uncomplicated Stanford type B aortic dissection (uSTBAD).

Methods: An electronic search of PubMed, Cochrane Central and Google Scholar was conducted for studies comparing TEVAR with OMT for mortality in adult patients with uSTBAD. Relevant outcomes, including mortality, aortic rupture, re-intervention, retrograde type A dissection, myocardial infarction and stroke were analyzed and presented as risk ratios (RRs) along with their 95% confidence intervals (95% CI). A p-value of less than 0.05 was considered significant in all cases. All statistical analysis was conducted using Review Manager.

Results: A total of 12 studies were included (n = 25,605). Meta-analysis favored TEVAR over OMT for all-cause mortality (RR = 0.57, 95% CI: [0.43-0.76]; P < 0.01). However, there was no significant difference considering the morbidity, which included endovascular re-intervention (RR = 0.76, 95%CI: [0.46-1.28]; P = 0.30), aortic rupture (RR = 0.38; 95%CI: [0.14-1.05]; P = 0.06), retrograde type A dissection (RR = 1.00; 95%CI: [0.78-1.28]; P = 1.00), myocardial infarction (RR = 0.85; 95% CI: [0.51-1.42]; P = 0.53). However, a significant increase in risk of stroke in TEVAR group was observed (RR = 1.56; 95%CI: [1.30-1.89]; P < 0.01).

Conclusion: We report that while there were similar morbidity outcomes for uSTBAD treated with TEVAR and OMT, overall mortality was significantly improved with TEVAR. Further large-scale studies are needed to elucidate the differences in outcomes between the two treatment options.

Protocol registration: https://www.crd.york.ac.uk/prospero identifier is CRD42024566452.