TEVAR Versus Optimal Medical Therapy for Uncomplicated Type B Aortic Dissection: A Systematic Review & Meta-analysis

Background: This meta-analysis reviewed the outcomes of patients with uncomplicated Type B aortic dissection (unTBAD) treated with either thoracic endovascular aortic repair (TEVAR) plus optimal medical therapy (OMT) or OMT alone. The study evaluated both short-term and long-term outcomes to assess whether TEVAR improved overall mortality and reduced complications such as retrograde type A dissection, stroke, paraplegia, and aortic remodeling. Methods: We conducted comprehensive searches on PubMed, Ovid, Scopus, and Excerpta Medica Database (EMBASE) to identify studies comparing long-term outcomes of TEVAR and OMT for unTBAD. Using the Population, Intervention, Comparator, and Outcome (PICO) framework and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we formulated the search query. The search was limited to titles and abstracts and included thorough citation reviews. Each study was evaluated against strict inclusion and exclusion criteria for eligibility. Statistical analysis was performed using Jamovi (Version 2.5) from the Jamovi project (2024). Results: The total number of patients with unTBAD in our analysis was 25,650, with 21,041 receiving optimal medical therapy (OMT) and 4,609 treated with TEVAR. The OMT group had an average age of 61.7 years, with 69.7% treated in the acute phase (<15 days). Their mean maximum aortic diameter was 38.5 mm, and the false lumen (FL) diameter averaged 25.4 mm. In the TEVAR group, the average age was 59.7 years, with 76.2% treated acutely. The average maximum aortic diameter was 40.2 mm, and the FL diameter was 26.4 mm. A pooled analysis showed no significant difference in 30-day and inhospital mortality rates (log odds ratio 0.1058, P = 0.4971). However, a random-effects model indicated a log odds ratio of -1.3696, resulting in an odds ratio of 0.2542 (P < 0.0001). Survival rates were 95.4% for the OMT group and 98% for the TEVAR group. At 1 year, survival was 90.2% for the OMT group (95% confidence interval [CI]: 85.7-90.7) and 94% for the TEVAR group (95% CI: 90.6-97.5). At 2 years, OMT survival was 71.8% (95% CI: 63.4-80.1) compared to 83.7% for TEVAR (95% CI: 75.6-91.8). At 3 years, survival was 82.2% for OMT (95% CI: 77.4-87) and 89.9% for TEVAR (95% CI: 86.1-93.7). Conclusion: The role of TEVAR in managing unTBAD remains debated. While studies show improved aortic remodeling post-TEVAR, there is no definitive evidence for increased survival rates. It is essential to conduct randomized trials and develop guidelines that include high-risk features for assessing this complex patient group.