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The Journal of Cardiovascular Surgery 2015 Feb 06


lingua: Inglese

Thoracic endovascular aortic repair or best medical therapy for uncomplicated Type B aortic dissection? A meta-analysis

Yang J., Shi Y., Jiang J.

Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China


AIM: To conduct a meta-­analysis of all studies comparing thoracic endovascular aortic repair (TEVAR) and best medical therapy (BMT) for treating uncomplicated Type B aortic dissection (TBAD).
METHODS: PubMed/Medline and Web of Knowledge were searched till September 2014 for relevant studies published in English. Pooled odds ratio (OR) and its corresponding 95% CI were analyzed with Cochrane Review Manager (Revman 5.3).
RESULTS: Our analysis showed that compared with BMT, TEVAR did not significantly affect 30-­day (hospital) mortality. A significantly lower 1-­year and 2-­ or 3 year survival rates was observed with TEVAR vs BMT. Interestingly, a trend just short of statistical significance towards higher 4-­ or 5-­year survival was found with TEVAR treatment ( P = 0.08). No significant differences were found in false lumen (FL) thrombosis formation with TEVAR vs BMT treatment. However, a trend toward less incomplete or no FL thrombosis was noted with TEVAR. No significantly impact on the risk of later re-­intervention was found with TEVAR vs BMT.
CONCLUSIONS: TEVAR did not provide obvious early survival advantage for uncomplicated TBAD over BMT, especially in the patients using TEVAR alone. It may remain a treatment option in uncomplicated TBAD patients with high risks for later complications. More randomized, prospective, long-­term studies are needed to further clarify whether TEVAR could be a better first-­line treatment strategy vs BMT for uncomplicated TBAD.

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