Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies.

Details

Serval ID
serval:BIB_995E87FD3702
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies.
Journal
Journal of the American College of Cardiology
Author(s)
Cheng Davy, Martin Janet, Shennib Hani, Dunning Joel, Muneretto Claudio, Schueler Stephan, Von Segesser Ludwig, Sergeant Paul, Turina Marko
ISSN
1558-3597[electronic], 0735-1097[linking]
Publication state
Published
Issued date
2010
Volume
55
Number
10
Pages
986-1001
Language
english
Abstract
OBJECTIVES: The purpose of this study was to determine whether thoracic endovascular aortic repair (TEVAR) reduces death and morbidity compared with open surgical repair for descending thoracic aortic disease. BACKGROUND: The role of TEVAR versus open surgery remains unclear. Metaregression can be used to maximally inform adoption of new technologies by utilizing evidence from existing trials. METHODS: Data from comparative studies of TEVAR versus open repair of the descending aorta were combined through meta-analysis. Metaregression was performed to account for baseline risk factor imbalances, study design, and thoracic pathology. Due to significant heterogeneity, registry data were analyzed separately from comparative studies. RESULTS: Forty-two nonrandomized studies involving 5,888 patients were included (38 comparative studies, 4 registries). Patient characteristics were balanced except for age, as TEVAR patients were usually older than open surgery patients (p = 0.001). Registry data suggested overall perioperative complications were reduced. In comparative studies, all-cause mortality at 30 days (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.33 to 0.59) and paraplegia (OR: 0.42, 95% CI: 0.28 to 0.63) were reduced for TEVAR versus open surgery. In addition, cardiac complications, transfusions, reoperation for bleeding, renal dysfunction, pneumonia, and length of stay were reduced. There was no significant difference in stroke, myocardial infarction, aortic reintervention, and mortality beyond 1 year. Metaregression to adjust for age imbalance, study design, and pathology did not materially change the results. CONCLUSIONS: Current data from nonrandomized studies suggest that TEVAR may reduce early death, paraplegia, renal insufficiency, transfusions, reoperation for bleeding, cardiac complications, pneumonia, and length of stay compared with open surgery. Sustained benefits on survival have not been proven.
Keywords
Endovascular, Descending Aorta, TEVAR, Meta-Analysis, Metaregression, Survival, Stent-Graft Repair, Controlled Clinical-Trial, Single-Center Experience, Of-Trauma Multicenter, Open Surgery, Operative Repair, Aneurysms, Rupture, Management, Injuries
Pubmed
Web of science
Open Access
Yes
Create date
24/03/2010 15:31
Last modification date
20/08/2019 15:00
Usage data