Long-term outcomes of thoracic endovascular aortic repair for the treatment of descending thoracic aortic aneurysms: a systematic review and meta-analysis.

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  • Additional Information
    • Source:
      Publisher: Edizioni Minerva Medica Country of Publication: Italy NLM ID: 0066127 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1827-191X (Electronic) Linking ISSN: 00219509 NLM ISO Abbreviation: J Cardiovasc Surg (Torino) Subsets: MEDLINE
    • Publication Information:
      Original Publication: Torino : Edizioni Minerva Medica
    • Subject Terms:
      Aortic Aneurysm, Thoracic*/surgery ; Aortic Aneurysm, Thoracic*/mortality ; Aortic Aneurysm, Thoracic*/diagnostic imaging ; Blood Vessel Prosthesis Implantation*/adverse effects ; Blood Vessel Prosthesis Implantation*/mortality ; Endovascular Aneurysm Repair*/adverse effects ; Endovascular Aneurysm Repair*/mortality; Aged ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
    • Abstract:
      Introduction: We undertook a systematic review of the currently published literature on TEVAR for DTAAs and we combined the eligible studies into a meta-analysis with the intention of evaluating the efficacy and the long-term durability of this treatment option.
      Evidence Acquisition: A systematic search of the literature from January 2015 up to December 2022 was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. For events during follow-up we calculated the incidence rates (IRs) with 95% confidence intervals (95% CIs) per 100 patient-years (p-ys) as the number of patients with outcome events occurring during the specific time period divided by the total number of p-ys.
      Evidence Synthesis: A total of 4127 study titles were identified by the initial search strategy, of which 12 were considered eligible for inclusion in the meta-analysis. A Total of 1976 patients (62% male) were identified among the eligible studies. One-year survival was 90.1% (95% CI 86.3% to 93.0%), 3-year survival was estimated at 80.5% (95% CI 69.2% to 88.4%) and the 5-year survival was estimated at 73.2% (95%CI 64.3% to 80.5%) with significant heterogeneity among studies regarding these outcomes. Regarding freedom from reintervention analysis for 1 year and 5 years was 96.5% (95% CI 94.5% to 97.8%) and 85.4% (95% CI 56.7% to 96.3%) respectively. The pooled late complications IR per 100 p-ys was 55.0 (95% CI 39.1 to 70.9), whereas the pooled IR for late reinterventions per 100 p-ys was 21.2 (95% CI 26.0 to 87.5). Late type I endoleak was reported with a pooled IR of 26.7 per 100 p-ys (95% CI 19.8 to 33.6) and late type III endoleak with a pooled IR of 7.6 per 100 p-ys (95% CI 5.5 to 9.7).
      Conclusions: TEVAR presents a safe and feasible solution for the treatment of DTAA with sustained long-term effectivity. Current evidence supports a satisfactory 5-year survival with low rates of reinterventions.
    • Publication Date:
      Date Created: 20230619 Date Completed: 20240509 Latest Revision: 20240820
    • Publication Date:
      20240821
    • Accession Number:
      10.23736/S0021-9509.23.12648-6
    • Accession Number:
      37335279