Long-term efficacy of endovascular vs open surgical repair for complicated type-B aortic dissection: a single-center retrospective study and meta-analysis

This study aimed to evaluate the long-term survival and risk factors of traditional open surgical repair (OSR) vs thoracic endovascular aneurysm repair (TEVAR) for complicated type-B aortic dissection (TBAD). A total of 118 inpatients (45 OSR vs 73 TEVAR) with TBAD were enrolled from January 2004 to January 2015. Kaplan-Meier curves and Cox proportional hazards analysis were performed to identify the long-term survival rate and independent predictors of survival, respectively. Meta-analysis was used to further explore the long-term efficacy of OSR and TEVAR in the eight included studies using Review Manager 5.2 software. An overall 10-year survival rate of 41.9% was found, and it was similar in the two groups (56.7% OSR vs 26.1% TEVAR; log-rank P=0.953). The risk factors of long-term survival were refractory hypertension (OR=11.1; 95%CI=1.428-86.372; P=0.021] and preoperative aortic diameter >55 mm (OR=4.5; 95%CI=1.842-11.346; P=0.001). Long-term survival rate did not differ significantly between OSR and TEVAR (hazard ratio=0.87; 95%CI=0.52-1.47; P=0.61). Compared with OSR, TEVAR did not show long-term advantages for patients with TBAD. Refractory hypertension and total aortic diameter >55 mm can be used to predict the long-term survival of TBAD in the Chinese Han population.

本研究旨在评估传统开放手术修复（open surgical repair, OSR）与胸主动脉腔内修复术（thoracic endovascular aneurysm repair, TEVAR）治疗复杂性B型主动脉夹层（complicated type-B aortic dissection, TBAD）的长期生存结局及相关危险因素。本研究于2004年1月至2015年1月期间纳入118例TBAD住院患者，其中OSR组45例，TEVAR组73例。分别采用Kaplan-Meier曲线与Cox比例风险回归分析，以明确患者长期生存率及生存独立预测因素；借助Review Manager 5.2软件，对纳入的8项研究开展Meta分析，进一步探讨OSR与TEVAR的长期临床疗效。研究整体10年生存率为41.9%，两组生存率无显著差异（OSR组56.7% vs TEVAR组26.1%；log-rank检验P=0.953）。影响长期生存的危险因素为难治性高血压（比值比[OR]=11.1；95%置信区间[CI]=1.428~86.372；P=0.021）及术前主动脉直径＞55mm（OR=4.5；95%CI=1.842~11.346；P=0.001）。OSR与TEVAR组的长期生存率无显著差异（风险比[HR]=0.87；95%CI=0.52~1.47；P=0.61）。与OSR相比，TEVAR治疗TBAD并未体现出长期生存获益。难治性高血压及主动脉总直径＞55mm可用于预测中国汉族人群TBAD患者的长期生存结局。