A systematic review and meta-analysis of total endovascular versus hybrid repair for the treatment of thoracoabdominal aortic aneurysms

Objective: Although open repair has been the traditional mainstay therapy for thoracoabdominal aortic aneurysms (TAAAs), it remains a surgical challenge. Recently, hybrid repair (HR) and total endovascular repair (TEVR) have emerged as viable alternatives in treating TAAAs. Thus, we aimed to compare the primary outcomes of in-hospital/30-day mortality, as well as secondary outcomes of postoperative complications including spinal cord ischemia, bowel ischemia, long-term dialysis, myocardial infarction and lower limb ischemia for HR vs TEVR for the treatment of TAAAs. We postulated that TEVR was associated with lower in-hospital and 30-day mortality and postoperative complication rates as compared with HR. Methods: Four scientific databases were searched from inception to November 18, 2021. Meta-analyses were performed for the primary and secondary outcomes. This study was conducted in adherence to the PRISMA guidelines. Results: The search yielded 3312 articles. After a two-stage selection process, five articles were included for final analysis. The in-hospital/30-day mortality rate for TEVR was significantly lower compared with HR (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.20-0.36; P < .00001). TEVR was also associated with reduced bowel ischemia (OR, 0.22; 95% CI, 0.14 -0.35; P < .00001) and long-term dialysis (OR, 0.22; 95% CI, 0.16-0.29; P < .00001). There was, however, no difference in the incidence of spinal cord ischemia (OR, 1.26; 95% CI, 0.74-2.14; P = .39), stroke (OR, 0.65; 95% CI, 0.10-4.20; P = .65), myocardial infarction (OR, 0.60; 95% CI, 0.17-2.05; P = .41), and lower limb ischemia (OR, 0.67; 95% CI, 0.29-1.55; P = .35). Most study outcomes had low heterogeneity. Findings were also robust to sensitivity analysis. Conclusions: Compared with the HR, TEVR of TAAAs were associated with lower in-hospital and 30-day mortality, bowel ischemia, and long-term dialysis.