A Systematic Review and Meta-Analysis on the Outcomes of Distal Aortic Interventions for Residual Aortic Dissection

Background The aim of the study was to determine the outcomes of distal open surgical repair (OSR) and endovascular repair (ER) for residual dissection after type A aortic dissection (TAAD) repair. Methods We conducted a systematic review and meta-analysis on studies reporting the outcomes of ER and OSR for distal residual dissection after TAAD repair. The MEDLINE, Embase, and Cochrane databases were searched for relevant articles; pooled prevalence of perioperative mortality, stroke, spinal cord ischemia (SCI), and follow-up reinterventions were reported for ER and OSR. Results We included 20 retrospective studies, yielding 1097 patients treated by ER or OSR. Pooled mortality for any distal reintervention was 6% (95% confidence interval [CI] 0.05-0.08, I-2 = 63%; P < 0.001), perioperative stroke rate was 3% (95% CI 0.02-0.04, I-2 = 32%; P = 0.119), and SCI rate was 0% (95% CI 0.00-0.01, I-2 = 14%; P = 0.301). Rate of aortic-related reintervention during follow-up was 13% (95% CI 0.06-0.23, I-2 = 91%; P < 0.001). Mortality was 5% (95% CI 0.02-0.11, I-2 = 57%) for reoperations on the aortic arch and 3% (95% CI 0.01-0.08, I-2 = 64%) for reinterventions on the descending thoracic aorta. ER provided a lower mortality particularly in the treatment of the descending aorta (1% vs. 6%, P = 0.16), with a higher risk for future reinterventions compared to OSR (10% vs. 2%, P = 0.005). Conclusion Distal aortic reoperations in TAAD survivors are associated with non-negligible mortality and stroke rates. Compared to OSR, ER provides lower mortality but a higher risk for future reinterventions; both ER and OSR techniques can be performed with a low risk for paraplegia. Further studies are needed to better investigate the specific comparative outcomes of ER and OSR.