Thoracic endovascular aortic repair versus open chest surgical repair for patients with type B aortic dissection: a systematic review and meta-analysis

Figures & data

Figure 1. Flow diagram of the literature search and study selection process.

Table 1. Baseline characteristic of studies included in the systematic review and meta-analysis.

Study	Country	Sample size	Mean age (years)	Percentage of male’s attendance	COPD (%)	Hypertension (%)	CAD (%)	Prior aortic dissection (%)	Diabetes (%)	Aneurysm (%)	Disease status	NOS score
Tsai 2006 [24]	11 countries	53 (27/26)	57.8 (60.2/55.3)	75.5 (67.0/85.0)	NA	66.0 (82.0/50.0)	18.9 (22.0/16.0)	3.8 (0.0/8.0)	7.5 (11.0/4.0)	13.2 (11.0/17.0)	Acute	8
Fattori 2008 [25]	9 countries	125 (66/59)	60.3 (58.8/61.9)	74.4 (71.2/78.0)	NA	76.0 (81.8/70.7)	27.2 (26.2/30.4)	11.2 (6.2/17.9)	8.0 (6.2/10.9)	19.2 (12.3/28.6)	Acute	8
Patel 2009 [26]	USA	69 (35/34)	65.9 (71.3/60.4)	59.4 (48.6/70.5)	24.6 (37.1/11.7)	73.9 (32.6/70.5)	26.1 (31.4/20.6)	13.0 (14.3/11.7)	11.6 (11.4/11.7)	31.9 (40.0/23.6)	Combined	6
Garbade 2010 [27]	Germany	51 (46/5)	64.5 (65.0/60.0)	68.6 (69.6/60.0)	19.6 (19.5/20.0)	88.2 (87.0/100.0)	NA	15.7 (13.0/40.0)	19.6 (19.6/20.0)	78.4 (75.0/100.0)	Acute	6
Mastroroberto 2010 [28]	Italy	24 (13/11)	72.4 (74.3/70.2)	62.5 (53.8/72.7)	62.5 (61.6/63.6)	79.2 (76.9/81.8)	8.3 (7.7/9.1)	NA	12.5 (7.7/18.2)	8.3 (7.7/9.1)	Acute	5
Zeeshan 2010 [29]	USA	65 (45/20)	58.1 (59.1/56.0)	73.8 (71.0/80.0)	15.4 (16.0/15.0)	76.9 (87.0/55.0)	12.3 (9.0/15.0)	NA	13.8 (18.0/5.0)	18.5 (25.0/16.0)	Acute	6
Conrad 2010 [30]	USA	2,701 (833/1868)	70.9 (71.7/70.6)	57.8 (57.0/58.0)	NA	NA	NA	NA	NA	NA	Combined	6
Sachs 2010 [7]	Israel	5,000 (1381/3619)	60.7	65.6 (66.4/65.3)	18.7 (21.3/17.7)	67.7 (73.3/65.5)	3.7 (7.0/2.5)	NA	7.6 (10.6/6.5)	NA	Combined	7
Brunt 2011 [31]	USA	564 (282/282)	61.4 (62.0/60.7)	70.7	22.0 (24.4/19.5)	74.0 (76.0/72.0)	39.9 (37.5/42.2)	NA	12.4 (14.0/10.7)	NA	Combined	7
Narayan 2011 [10]	UK	84 (49/35)	56.7 (57.5/55.5)	75.0 (69.0/81.0)	NA	50.0 (47.0/53.0)	8.3 (8.0/8.0)	NA	2.4 (2.0/2.0)	48.8	Combined	7
Wilkinson 2013 [32]	USA	73 (49/24)	66.2 (70.1/58.3)	63.0 (57.1/75.0)	16.4 (20.4/8.3)	80.8 (83.7/75.0)	26.0 (36.7/4.2)	24.7 (26.5/20.8)	11.0 (12.2/8.3)	100.0	Combined	7
Nozdrzykowski 2013 [33]	Germany	47 (32/15)	61.7 (62.0/61.0)	70.2 (71.9/66.7)	19.1 (21.9/13.3)	100.0	17.0 (18.8/13.3)	21.3 (18.8/26.7)	19.1 (28.1/0.0)	74.5 (65.6/93.3)	Chronic	7
Andersen 2014 [34]	USA	107 (44/63)	56.0	72.0	16.8	100.0	16.8	56.1	6.5	100.0	Chronic	7
van Bogerijen 2015 [35]	USA	122 (32/90)	59.8 (69.2/56.4)	69.7 (46.9/77.8)	8.2 (25.0/2.2)	91.0 (93.8/90.0)	15.6 (25.0/12.2)	32.0 (34.4/31.1)	9.0 (9.4/9.0)	8.2 (18.8/4.4)	Chronic	8
Afifi 2015 [36]	USA	89 (37/52)	60.0 (61.3/59.0)	61.8 (67.6/57.7)	NA	NA	NA	NA	NA	NA	Acute	6
Chou 2015 [37]	China	226 (113/113)	62.6 (62.6/62.5)	83.2 (83.2/83.2)	9.7 (9.7/9.7)	80.5 (81.4/79.6)	3.1 (2.7/3.5)	NA	12.8 (10.6/15.0)	NA	Combined	8
Zhu 2016 [38]	China	118 (73/45)	52.7 (55.0/48.9)	72.9 (65.8/84.4)	11.0 (15.1/4.4)	93.2 (94.5/91.1)	30.5 (34.2/24.4)	NA	9.3 (9.6/8.9)	NA	Combined	7
Lou 2018 [39]	USA	146 (87/59)	57.0 (59.5/53.4)	71.2 (67.8/76.3)	12.3 (12.6/11.9)	94.5 (92.0/98.3)	NA	NA	12.3 (20.0/8.8)	NA	Combined	7

CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; NA: not available.

Figure 2. TEVAR versus OCSR for the risk of in-hospital mortality.

Table 2. Subgroup analysis for in-hospital mortality.

Factor	Groups	Number of studies	OR and 95% CI	p Value	Heterogeneity (%)	p Value for heterogeneity	p Value between subgroups
Sample size	≥100	9	0.42 (0.27–0.65)	<.001	47.3	.056	.758
	<100	9	0.35 (0.19–0.64)	.001	20.0	.265
Mean age (years)	≥60.0	10	0.47 (0.29–0.75)	.002	53.9	.021	.171
	<60.0	8	0.27 (0.16–0.48)	<.001	0.0	.796
Percentage of male’s attendance	≥70.0	10	0.29 (0.19–0.43)	<.001	0.0	.642	.074
	<70.0	8	0.58 (0.31–1.06)	.078	53.7	.034
Percentage of COPD	≥20.0	3	0.44 (0.22–0.86)	.017	0.0	.373	.633
	<20.0	10	0.39 (0.19–0.79)	.008	49.5	.037
Percentage of hypertension	≥80.0	8	0.32 (0.18–0.57)	<.001	0.0	.833	.673
	<80.0	8	0.34 (0.17–0.67)	.002	60.7	.013
Percentage of CAD	≥20.0	5	0.40 (0.24–0.67)	.001	0.0	.704	1.000
	<20.0	9	0.30 (0.13–0.65)	.002	57.7	.015
Percentage of DM	≥10.0	9	0.31 (0.19–0.50)	<.001	7.9	.369	.297
	<10.0	7	0.45 (0.22–0.93)	.031	45.4	.088
Disease status	Acute	6	0.30 (0.13–0.73)	.007	48.9	.081	.696
	Chronic	3	0.38 (0.10–1.41)	.148	0.0	.739
	Combined	9	0.44 (0.29–0.66)	<.001	43.5	.078
Quality of study	High	12	0.41 (0.26–0.63)	<.001	29.7	.155	.464
	Low	6	0.36 (0.18–0.74)	.005	45.0	.105

Figure 3. TEVAR versus OCSR for the risk of stroke.

Table 3. Subgroup analysis for stroke.

Factor	Groups	Number of studies	OR and 95% CI	p Value	Heterogeneity (%)	p Value for heterogeneity	p Value between subgroups
Sample size	≥100	7	1.19 (0.47–3.04)	.710	42.2	.109	.300
	<100	6	0.67 (0.22–1.99)	.469	14.0	.325
Mean age (years)	≥60.0	8	1.05 (0.55–2.02)	.875	7.8	.370	1.000
	<60.0	5	0.86 (0.12–5.93)	.876	59.2	.044
Percentage of male’s attendance	≥70.0	7	0.92 (0.30–2.85)	.885	51.1	.056	.879
	<70.0	6	0.98 (0.42–2.30)	.970	0.0	.418
Percentage of COPD	≥20.0	3	0.82 (0.16–4.31)	.814	37.0	.205	.888
	<20.0	8	0.94 (0.35–2.55)	.902	38.1	.126
Percentage of hypertension	≥80.0	6	0.72 (0.18–2.82)	.639	50.6	.072	.338
	<80.0	6	1.16 (0.57–2.34)	.685	0.0	.417
Percentage of CAD	≥20.0	4	0.76 (0.27–2.14)	.600	33.7	.210	.165
	<20.0	7	0.74 (0.23–2.34)	.606	34.4	.166
Percentage of DM	≥10.0	8	1.09 (0.48–2.49)	.831	18.0	.288	.355
	<10.0	4	0.57 (0.12–2.69)	.478	55.0	.083
Disease status	Acute	4	1.08 (0.27–4.28)	.912	21.7	.280	.183
	Chronic	3	0.28 (0.02–3.24)	.306	59.0	.087
	Combined	6	1.39 (0.70–2.77)	.350	3.3	.395
Quality of study	High	9	0.92 (0.41–2.08)	.842	39.6	.104	.852
	Low	4	1.15 (0.22–6.04)	.867	24.7	.263

Figure 4. TEVAR versus OCSR for the risk of myocardial infarction.

Figure 5. TEVAR versus OCSR for the risk of acute renal failure.

Table 4. Subgroup analysis for acute renal failure.

Factor	Groups	Number of studies	OR and 95% CI	p Value	Heterogeneity (%)	p Value for heterogeneity	p Value between subgroups
Sample size	≥100	7	0.36 (0.15–0.89)	.026	74.3	.001	.138
	<100	7	0.81 (0.39–1.67)	.569	44.5	.095
Mean age (years)	≥60.0	9	0.55 (0.28–1.11)	.095	68.1	.001	.647
	<60.0	5	0.47 (0.14–1.52)	.206	63.8	.026
Percentage of male’s attendance	≥70.0	8	0.41 (0.19–0.88)	.023	65.4	.005	.001
	<70.0	6	1.12 (0.72–1.75)	.608	0.0	.487
Percentage of COPD	≥20.0	2	0.13 (0.05–0.31)	<.001	0.0	.640	<.001
	<20.0	9	0.74 (0.40–1.36)	.328	43.8	.076
Percentage of hypertension	≥80.0	7	0.46 (0.25–0.83)	.010	0.0	.723	.133
	<80.0	6	0.50 (0.17–1.48)	.210	82.6	<.001
Percentage of CAD	≥20.0	3	0.23 (0.09–0.61)	.003	36.4	.207	.002
	<20.0	8	0.68 (0.35–1.34)	.265	56.0	.026
Percentage of DM	≥10.0	8	0.45 (0.18–1.09)	.077	65.3	.005	.035
	<10.0	5	0.54 (0.23–1.25)	.147	57.9	.050
Disease status	Acute	5	0.95 (0.42–2.15)	.901	41.9	.142	.149
	Chronic	3	0.65 (0.26–1.62)	.353	0.0	.583
	Combined	6	0.33 (0.12–0.92)	.034	79.7	<.001
Quality of study	High	10	0.40 (0.20–0.78)	.008	65.3	.002	.012
	Low	4	1.26 (0.55–2.91)	.581	27.7	.246

Figure 6. TEVAR versus OCSR for the risk of respiratory failure.

Figure 7. TEVAR versus OCSR for the risk of paraplegia.

Figure 8. TEVAR versus OCSR for the risk of bleeding, mesenteric ischaemia/infarction, reinterventions, sepsis, and spinal cord ischaemia.

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Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.