Thoracic endovascular aortic repair for hyperacute, acute, subacute and chronic type B aortic dissection: Meta-analysis of reconstructed time-to-event data

Since the optimal timing for thoracic endovascular aortic repair (TEVAR) in the context of type B aortic dissections (TBAD) remains an open question, we performed a systematic review with meta-analysis to evaluate outcomes of TEVAR according to the phases of TBAD - hyperacute, acute, subacute and chronic. We carried out a pooled meta-analysis of time-to-event data extracted from studies published by June 2023 for the following outcomes: all-cause mortality, aortic-related mortality, and late aortic reinterventions. Thirteen studies met our eligibility criteria, comprising 4,793 patients (10.3% hyperacute, 51.9% acute, 25.9% subacute, 11.9% chronic). Considering the overall population, we observed a statistically significant difference between the groups (Log-rank test, P<0.0001) and the main differences were found in the following comparisons: hyperacute versus acute (HR 1.61; 95%CI 1.21-2.13; P=0.001); hyperacute versus chronic (HR 1.70; 95%CI 1.17-2.46; P=0.005); subacute versus acute (HR 0.78; 95%CI 0.63-0.98; P=0.032). Considering the population with uncomplicated TBAD, we also observed a statistically significant difference for all-cause death between the groups (Log-rank test, P<0.0001) and the main differences were found in the comparisons for subacute versus acute (HR 0.72; 95%CI 0.58-0.88; P=0.002). Furthermore, we observed statistically significant differences between the groups for aortic-related death (Log-rank test, P<0.0001) and late aortic reintervention (Log-rank test, P<0.0001), all favoring mostly the subacute phase as the optimal timing for TEVAR. In conclusion, there seems to be a timing-specific difference in the outcomes of TEVAR for TBAD pointing to the subacute phase as the optimal timing to achieve better long-term outcomes.