Objective: This report provides a concise overview of the published literature and clinical outcomes on ascending thoracic endovascular aortic repair (aTEVAR) for diseases originating in, but not restricted to, the ascending aorta. Methods: PubMed, Scopus, and Web of Science were systematically searched for aTEVAR procedures for diseases originating in the ascending aorta. Nonadult patients or studies with fewer than 5 patients were excluded. This review was registered in the International Prospective Register of Systematic Reviews and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements. The Risk of Bias in Non-randomized Studies - of Interventions tool was used to assess quality. A Grading of Recommendations, Assessment, Development, and Evaluation evidence certainty analysis was performed. Results: One prospective and 22 retrospective studies included a total of 356 patients (weighted mean age 68.6 ± 10.9 years; 59.3% male). The weighted mean follow-up was 21.2 ± 20.3 months, and prevalent comorbidities were hypertension (72.8%) and coronary artery disease (24.2%). Indications included type A dissections (acute 36.0%; chronic 19.9%), penetrating aortic ulcer (11.5%), and pseudoaneurysm (16.9%). Rapid ventricular pacing (33.4%) was most frequently adopted strategy to reduce cardiac output, and femoral/iliac artery access was used in 84.3%. Tubular stent grafts were used in 229 cases (64.3%), whereas physician-modified stent grafts were necessary in 110 cases (30.9%). In-hospital and follow-up mortality rates were 10.7% (95% CI, 6.3-13.1) and 20.5% (95% CI, 16.4-25.1). Subgroup analyses showed in-hospital and follow-up mortality rates for (acute and chronic) type A dissections of 9.8% (95% CI, 5.9-15.0) and 18.0% (95% CI, 12.7-24.3) subsequently; for penetrating aortic ulcer 9.0% (95% CI, 1.9-24.3) and 15.2% (95% CI, 5.1-31.9); and for pseudoaneurysm 2.8% (95% CI, 1.0-13.9) and 13.3% (95% CI, 5.9-24.6). Intra- and postoperative complications were reported in 43 and 192 cases, with endoleaks occurring in 14 (3.9%) and 37 (10.4%) cases, respectively. Conclusions: This systematic review assessed current strategies and outcomes for aTEVAR. The findings suggest that aTEVAR holds promise as a treatment option and highlight the potential for further integration of aTEVAR into clinical practice.
Endovascular repair of diseases originating in the ascending thoracic aorta: A systematic review and meta-analysis
Piffaretti G.Writing – Review & Editing
;
2025-01-01
Abstract
Objective: This report provides a concise overview of the published literature and clinical outcomes on ascending thoracic endovascular aortic repair (aTEVAR) for diseases originating in, but not restricted to, the ascending aorta. Methods: PubMed, Scopus, and Web of Science were systematically searched for aTEVAR procedures for diseases originating in the ascending aorta. Nonadult patients or studies with fewer than 5 patients were excluded. This review was registered in the International Prospective Register of Systematic Reviews and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements. The Risk of Bias in Non-randomized Studies - of Interventions tool was used to assess quality. A Grading of Recommendations, Assessment, Development, and Evaluation evidence certainty analysis was performed. Results: One prospective and 22 retrospective studies included a total of 356 patients (weighted mean age 68.6 ± 10.9 years; 59.3% male). The weighted mean follow-up was 21.2 ± 20.3 months, and prevalent comorbidities were hypertension (72.8%) and coronary artery disease (24.2%). Indications included type A dissections (acute 36.0%; chronic 19.9%), penetrating aortic ulcer (11.5%), and pseudoaneurysm (16.9%). Rapid ventricular pacing (33.4%) was most frequently adopted strategy to reduce cardiac output, and femoral/iliac artery access was used in 84.3%. Tubular stent grafts were used in 229 cases (64.3%), whereas physician-modified stent grafts were necessary in 110 cases (30.9%). In-hospital and follow-up mortality rates were 10.7% (95% CI, 6.3-13.1) and 20.5% (95% CI, 16.4-25.1). Subgroup analyses showed in-hospital and follow-up mortality rates for (acute and chronic) type A dissections of 9.8% (95% CI, 5.9-15.0) and 18.0% (95% CI, 12.7-24.3) subsequently; for penetrating aortic ulcer 9.0% (95% CI, 1.9-24.3) and 15.2% (95% CI, 5.1-31.9); and for pseudoaneurysm 2.8% (95% CI, 1.0-13.9) and 13.3% (95% CI, 5.9-24.6). Intra- and postoperative complications were reported in 43 and 192 cases, with endoleaks occurring in 14 (3.9%) and 37 (10.4%) cases, respectively. Conclusions: This systematic review assessed current strategies and outcomes for aTEVAR. The findings suggest that aTEVAR holds promise as a treatment option and highlight the potential for further integration of aTEVAR into clinical practice.
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