Systematic Review Of Short And Middle-term Mortality Of Stanford B Thoracic Aortic Dissection By Endovascular Aortic Repair Versus Medical Therapy

Background:Thoracic endovascular aortic repair (TEVAR) represents a novel treatment for Stanford B aortic dissection. If TEVAR is supper to classic medical therapy for Stanford B thoracic aortic dissection remains an unsolved question.Object:The purpose of this study was to compare the short and middle-term mortality of thoracic endovascular aortic repair (TEVAR) with medical therapy in Stanford B thoracic aortic dissection.Methods:A search was performed to identify all studies of TEVAR versus medical therapy for descending thoracic aortic dissection in MEDLINE, Cochrane Central Register of Controlled Trials on The Cochrane Library, EMBASE and WANFANG full-text Database, CNKI Database, the China Biological Medicine Database. Data from comparative studies of TEVAR versus open repair of the descending aorta were combined through meta-analysis. Meta regression was performed to measure the impact of risk factor imbalances for baseline characteristics and study design.Results:Twelve studies involving1408patients of AD were included (TEVAR:506, MEDICAL:902). Patient characteristics were balanced except for males constitute ratio, as TEVAR patients were usually man than MEDICAL patients (p<0.05). In comparative studies, all cause mortality at30days TEVAR 4.6%(18/388), MEDICAL7.5%(56/750)odds ratio [OR]:0.74,95%confidence interval [CI]:(0.33to0.59)P=0.28, no significant difference. All cause mortality at1year TEVAR8.3%(34/409), MEDICAL9.7%(62/638) odds ratio [OR]:1.01,95%confidence interval [CI]:(0.46to2.18)P=0.99, no significant difference. All cause mortality at2-3years TEVAR16.3%(34/208), MEDICAL18.5%(81/437) odds ratio [OR]:1.16,95%confidence interval [CI]:(0.72to1.88)P=0.53, no significant difference. All cause mortality at4-5years TEVAR28.1%(34/121), MEDICAL22.4%(51/227)odds ratio [OR]:1.33,95%confidence interval [CI]:(0.73to2.45)P=0.53, no significant difference was observed. All cause mortality at Reintervention TEVAR was12.2%(29/238), MEDICAL14.5%(54/372) odds ratio [OR]:0.81,95%confidence interval [CI]:(0.48to1.36)P=0.42, also significant difference was not observed.Conclusions:Current data suggest that mortality of30-days,1-year,2to3years,4to5years and overall reintervention rate between TEVAR and MEDICAL in Stanford B aortic dissection patients exist no significant difference, however it is necessary that more large-scale clinical randomized controlled trials will be employed to test conclusion.