REVIEW  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2022 February;63(1):25-36

DOI: 10.23736/S0021-9509.21.11894-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Effectiveness of endovascular versus open surgical repair for thoracic aortic aneurysm: a systematic review and meta-analysis

Alireza MAHBOUB-AHARI ^{1, 2}, Fatemeh SADEGHI-GHYASSI ², Fariba HEIDARI ² ✉

¹ Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; ² Research Center for Evidence-Based Medicine: a JBI Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran

INTRODUCTION: Since the approval, the thoracic endovascular aortic repair (TEVAR) is widely used for the repair of thoracic aortic aneurysm. However, the long-term mortality and re-intervention rates compared to open surgical repair (OSR) are unclear. We aimed to compare the effectiveness of TEVAR with OSR specifically for thoracic aortic aneurysms.
EVIDENCE ACQUISITION: We conducted a comprehensive search in MEDLINE, PubMed, EMBASE, CINAHL, PROSPERO, Centre for Reviews and Dissemination, and the Cochrane Library up to November 2020. The main outcomes were early mortality, mid-to-long-term survival, and re-intervention. The quality of the evidence was assessed using the GRADE methodology. All analyses were performed using RevMan with the random effect model and Comprehensive Meta-Analysis software.
EVIDENCE SYNTHESIS: One systematic review and 15 individual studies were included. Pooled analysis showed that 30-day mortality, stroke, renal failure, and pulmonary complications were significantly lower in TEVAR versus open surgery. The pooled rate of re-intervention significantly favored the OSR. The long-term survival and mortality favored TEVAR and OSR in one and two studies, respectively, but was non-significant in seven analyzes.
CONCLUSIONS: Early clinical outcomes including the 30-day mortality, stroke, renal failure, and pulmonary complications significantly favored the TEVAR. However, the mid-to-long-term re-intervention rate favored the OSR and long-term survival was inconsistent among the studies. The quality of evidence was very low. More studies with longer follow-ups are needed. The use of TEVAR should be decided by taking into account other factors including patient characteristics and preferences, cost, and surgeon expertise.

KEY WORDS: Thoracic aortic aneurysm; Endovascular procedures; Operative surgical procedures; Systematic review