effectiveness of endovascular versus open surgical repair for thoracic aortic aneurysm: a systematic review and meta-analysis

iNTroduCTioN: since the approval, the thoracic endovascular aortic repair (TeVar) is widely used for the repair of thoracic aortic aneurysm. however, the long-term mortality and re-intervention rates compared to open surgical repair (osr) are unclear. We aimed to compare the effectiveness of TEVAR with OSR specifically for thoracic aortic aneurysms. eVideNCe aCQuisiTioN: We conducted a comprehensive search in MedliNe, PubMed, eMBase, CiNahl, ProsPero, Centre for reviews and dissemination, and the Cochrane library up to November 2020. The main outcomes were early mortality, mid-to-long-term survival, and re-intervention. The quality of the evidence was assessed using the grade methodology. all analyses were performed using revMan with the random effect model and Comprehensive Meta-analysis software. eVideNCe syNThesis: one systematic review and 15 individual studies were included. Pooled analysis showed that 30-day mortality, stroke, renal failure, and pulmonary complications were significantly lower in TEVAR versus open surgery. The pooled rate of re-intervention significantly favored the OSR. The long-term survival and mortality favored TEVAR and OSR in one and two studies, respectively, but was non-significant in seven analyzes. CONCLUSIONS: Early clinical outcomes including the 30-day mortality, stroke, renal failure, and pulmonary complications significantly favored the TeVar. however, the mid-to-long-term re-intervention rate favored the osr and long-term survival was inconsistent among the studies. The quality of evidence was very low. More studies with longer follow-ups are needed. The use of TeVar should be decided by taking into account other factors including patient characteristics and preferences, cost, and surgeon expertise.