Open versus Endovascular Repair of Descending Thoracic Aortic Aneurysm Disease: A Systematic Review and Meta-analysis

Background: The purpose of this study was to determine whether thoracic endovascular aortic repair reduces death and morbidity compared with open surgical repair for descending thoracic aortic disease. Methods: A comprehensive search was undertaken among the 4 major databases (PubMed, Embase, Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing open versus endovascular repair in thoracic aortic aneurysm. Databases where evaluated and assessed to July 2017. Odds ratios, weighted mean differences, or standardized mean differences and their 95% confidence intervals were analyzed. Results: A total of 14,580 patients were analyzed in total of 13 articles, which were included in the synthesis of the meta-analysis. A total of 10,672 patients had open repair, and 3,908 patients had endovascular repair. Patients undergoing open repair were younger (mean of 65.1 years vs. 70.0 years, P = 0.0009), and there was higher elective rate in open repair patient (83.4% vs. 81%, P = 0.36). Duration of intensive care and total hospital stay was much shorter in endovascular patients (4.5 vs. 8.5 days, P = 0.002 and 5.7 vs. 9.5 days, P = 0.0004). Postoperative stroke was similar in both groups (P = 0.58); however, higher rate of paraplegia noted in open repair group (P = 0.007). The rate of renal failure (P = 0.01) and cardiac complications (P < 0.0001) was higher in the open repair group. The rate of vascular complications was much higher in the endovascular group of patients (5.29% vs. 1.17%, P = 0.002). Operative mortality was higher in endovascular procedures (4.4% vs. 3.2%, P = 0.005); however, 1- and 5-year mortality showed no statistical difference between the endovascular and open repair groups (22.19%, vs. 24.04%, P = 0.59, and 44.26% vs. 37.37%, P = 0.49). Conclusions: The present meta-analysis shows that endovascular repair of thoracic aortic aneurysm gives better perioperative outcomes during inhospital stay although the 1- and 5-year mortality remains the same in both groups; but the long-term outcome is yet to be established. A long-term data and studies are required to give a better understanding of comparing these 2 techniques beyond 5 years of follow-up.