Key result
TEVAR is linked to ~40% lower operative mortality vs. open surgical repair.
Why the study?
Descending thoracic aortic aneurysms require prompt treatment, but the comparative effectiveness and safety of TEVAR versus open surgical repair needed comprehensive evaluation for perioperative and long-term outcomes.
Does thoracic endovascular aortic repair (TEVAR) reduce operative mortality and improve perioperative outcomes compared to open surgical repair in patients with descending thoracic aortic aneurysms?
Meta-Analysis (n=29,465)
Does thoracic endovascular aortic repair (TEVAR) reduce operative mortality and improve perioperative outcomes compared to open surgical repair in patients with descending thoracic aortic aneurysms?
Odds Ratio: 0.6 (95% CI 0.42–0.85)
p-value: p=0.004
TEVAR offers superior perioperative outcomes and lower operative mortality compared to open surgical repair for descending thoracic aortic aneurysms, though long-term mortality is similar and vascular complications are higher.
TEVAR linked to lower perioperative mortality and morbidity than OSR; supports preference in suitable patients but leaves long-term durability open.
BACKGROUND Descending thoracic aortic aneurysms are dangerous and have to be treated quickly. The primary treatment methods are thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR). The comparative effectiveness and safety of TEVAR and OSR were evaluated in this meta-analysis, focusing on perioperative and long-term outcomes. AIM To compare and contrast the efficacy and safety of TEVAR vs OSR in the treatment of descending thoracic aortic aneurysms. This study aims to assess both perioperative and long-term outcomes through a systematic review and meta-analysis. METHODS A comprehensive search of PubMed, EMBASE, and Cochrane was conducted from inception to January 2025. Baseline characteristics and outcomes were evaluated. Odds ratios (OR) for dichotomous data and mean differences for continuous data with 95% confidence intervals (CI) were analyzed using random-effects models. RESULTS A meta-analysis of 21 studies involving 29465 patients (8261 TEVAR; 21204 OR) showed TEVAR associated with lower operative mortality (OR = 0.60, 95%CI: 0.42-0.85, P = 0.004), shorter intensive care unit (-2.94 days, 95%CI: -4.76 to -1.12, P = 0.002) and hospital stays (-7.35 days, 95%CI: -10.54 to -4.17, P < 0.00001), and reduced rates of paraplegia (OR = 0.44, 95%CI: 0.27-0.73, P = 0.002), spinal ischemia (OR = 0.30, 95%CI: 0.16-0.56, P = 0.0002), renal failure (OR = 0.29, 95%CI: 0.14-0.61, P = 0.001), and wound infections (OR = 0.28, 95%CI: 0.13-0.61, P = 0.001). However, TEVAR had higher rates of vascular complications. No significant differences were noted in 1-year and 5-year mortality rates, the rate of non-elective surgery, neurological complications, or stroke rates. CONCLUSION Compared to EVAR, TEVAR revealed lower operative mortality and better perioperative outcomes across all indicators, including hospital and intensive care unit stays, as well as fewer complications, except for those related to vascular problems. Mortality results were also similar in the long run; consequently, more research is required concerning the long-term durability.
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Khawar et al. (2025) conducted a meta-analysis in Descending thoracic aortic aneurysms (n=29,465). Thoracic endovascular aortic repair (TEVAR) vs. Open surgical repair (OSR) was evaluated on Operative mortality (OR 0.60, 95% CI 0.42-0.85, p=0.004). Thoracic endovascular aortic repair was associated with lower operative mortality compared to open surgical repair (OR 0.60; 95% CI 0.42-0.85; P=0.004).
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