Key result
TEVAR cuts 30-day mortality ~56% compared with open repair for descending thoracic aortic disease.
Why the study?
The role of thoracic endovascular aortic repair versus open surgical repair for descending thoracic aortic disease remains unclear.
Does thoracic endovascular aortic repair reduce death and morbidity compared with open surgical repair in patients with descending thoracic aortic disease?
Meta-Analysis (n=5,888)
Yes
Does thoracic endovascular aortic repair reduce death and morbidity compared with open surgical repair in patients with descending thoracic aortic disease?
TEVAR is associated with reduced early mortality and perioperative morbidity compared to open surgical repair for descending thoracic aortic disease, though long-term survival benefits remain unproven.
Answers are grounded in this paper and cite their sources.
Supports TEVAR over open repair for descending thoracic aortic disease; leaves open long-term survival and randomized confirmation.
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.
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Cheng et al. (2010) conducted a meta-analysis in Descending thoracic aortic disease (n=5,888). Thoracic endovascular aortic repair (TEVAR) vs. Open surgical repair was evaluated on All-cause mortality at 30 days (OR 0.44, 95% CI 0.33-0.59). TEVAR reduced 30-day all-cause mortality compared with open surgical repair for descending thoracic aortic disease (OR 0.44; 95% CI 0.33-0.59).
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