Proportional meta-analysis of open surgery or fenestrated-endograft repair for post-dissection thoracoabdominal aneurysms.

OBJECTIVE To determine outcomes of post-dissection thoracoabdominal aneurysms (pD-TAAAs) by either open or endovascular repair with fenestrated or branched endografts (F/B-TEVAR). METHODS A systematic review was conducted for open or endovascular repair of pD-TAAAs, between January 2009 and February 2020. A meta-analysis was performed for post-operative complications and both early and late mortality and re-interventions. RESULTS 15 non-comparative studies (8 endovascular repair and 7 open repair) were suitable for meta-analysis. Overall 1337 patients were included, 1068 in the open repair group (73% males, mean age 58 years) and 269 in the endovascular repair group (79% males, mean age 65 years) The 30-day mortality was 6% for open repair vs. 3% for endovascular repair (p=.35), while the 30-day re-intervention rate was 3% for open repair vs. 1% for endovascular repair (p= .66). The only significant difference was reported for 30-day respiratory complication rate (30% open repair vs. 2% endovascular repair; p< .01). Spinal cord ischemia (SCI) incidence was 9% for open repair vs. 8% for endovascular repair (p= .95). Mean follow-up was 44 months: 48 months (range 10-72) after open repair and 17 months (range 12-25) after endovascular repair (p< .01). Late aortic re-interventions were more frequent after endovascular repair (11% vs. 32%; p< .001). Late overall mortality rate was 19% for open repair vs. 7% for endovascular repair (p= .08) while aortic related mortality was 7% for open repair vs 3% for endovascular repair (p= .22) CONCLUSIONS: In absence of comparative studies, this meta-analysis showed that endovascular repair appears to be a valuable alternative for patients unfit for open repair.