The Evaluation of Outcomes after Thoracic Endovascular Aortic Repair for Type B Aortic Dissection in Mainland China

Abstract

Background: To assess the mortality and outcomes after thoracic endovascular aortic repair (TEVAR) in patients with type B aortic dissection (TBAD) in mainland China, and to compare these outcomes with data from Western countries, while analyzing the potential reasons for differences among different countries. Methods: An extensive literature search spanning from January 1999 to October 2023 was conducted using PubMed, Cochrane Library, and Embase databases for studies on endovascular treatment for TBAD. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data extraction and analysis followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Primary outcomes were in-hospital mortality and mid-term (< 5 years) mortality. Results: Based on 25 publications (3,080 patients), pooled estimate for in-hospital mortality was 2.2% (95% confidence interval, 1.6%–2.9%). Major perioperative complications included stroke (2.4% [1.8%–3.3%]), spinal cord ischemia (1.4% [1.0%–2.2%]), retrograde type A aortic dissection (1.2% [0.8%–1.8%]), type I endoleak (5.6% [3.6%–8.6%]), visceral ischemia (1.0% [0.5%–2.1%]), and acute renal failure (2.8% [2.0%–3.8%]). Mid-term mortality was 5.1% (3.6%–7.3%), and secondary intervention rate was 4.9% (4.0%–6.0%) with 1.7% (1.0%–2.9%) conversion rate to open surgery. In subgroup analysis based on uncomplicated TBAD, in-hospital and mid-term mortality was 0.5% (0.2%–1.5%) and 0.6% (0.2–1.7%), respectively. Compared with data from Western countries, mainland Chinese patients had a lower mortality. Conclusions: In mainland China, the outcomes of endovascular treatment for TBAD are comparable to those of Western countries. The large number of patients undergoing TEVAR in mainland China and its good performance support the use of TEVAR in uncomplicated TBAD.