Endovascular Aortic Repair Versus Open Surgical Repair for Descending Thoracic Aortic DiseaseA Systematic Review and Meta-Analysis of Comparative Studies
Davy Cheng, MD*,*,
Janet Martin, PharmD, MSc (HTA&M)*,
Hani Shennib, MBBS ,
Joel Dunning, PhD ,
Claudio Muneretto, MD ,
Stephan Schueler, PhD, MD||,
Ludwig Von Segesser, MD¶,
Paul Sergeant, MD, PhD# and
Marko Turina, MD*
*
* Department of Anesthesia & Perioperative Medicine, Evidence-Based Perioperative Clinical Outcomes Research Group London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
Vascular, Heart & Lung Associates, Phoenix, Arizona
Department Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
Department of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
|| Department for Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
¶ Cardiovascular Surgery, University Hospital CHUV, Lausanne, Switzerland
# Cardiac Surgery Department, Gasthuisberg University Hospital, Leuven, Belgium
** Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland. Support for the meta-analysis was provided by an unrestricted research grant from the European Association of Cardiothoracic Surgery (EACTS) and the Evidence-Based Perioperative Clinical Outcomes Research Group, University of Western Ontario. Dr. Shennib receives consulting fees from W. L. Gore. Part of this study was presented at the the 2009 ACC i2 Late-Breaking Clinical Trials Summit on March 30, 2009, in Orlando, Florida
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Figure 1 Results of Literature Search
The flow chart outlines the total number of potentially relevant citations reviewed and collected for full-text screening. Reasons for inclusion and exclusion are outlined. CoA = coarctation; nRCT = nonrandomized controlled trial.
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Figure 2 Death at 30 Days for TEVAR Versus Open Surgery
Meta-analysis comparing death at 30 days for thoracic endovascular aortic repair (TEVAR) versus open surgery. The odds ratio (OR) for death from each included study is plotted. A pooled estimate of overall OR (diamonds) and 95% confidence intervals (width of diamonds) summarizes the effect size using the random effects model. Effects to the left of 1.0 favor TEVAR; effects to the right favor open surgery. When the horizontal bars of an individual study, or the pooled diamond width, cross 1.0, the effect is not significantly different. The I2 for heterogeneity was not significant, suggesting homogeneity in effect size across each study.
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Figure 3 Death at 1 Year for TEVAR Versus Open Surgery
Meta-analysis comparing death at 1 year for thoracic endovascular aortic repair (TEVAR) versus open surgery. The odds ratio (OR) for death from each included study is plotted. A pooled estimate of overall OR (diamonds) and 95% confidence intervals (width of diamonds) summarizes the effect size using the random effects model. Effects to the left of 1.0 favor TEVAR; effects to the right favor open surgery. When the horizontal bars of an individual study, or the pooled diamond width, cross 1.0, the effect is not significantly different. The I2 for heterogeneity was not significant, suggesting homogeneity in effect size across each study.
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Figure 4 Death at 2 to 3 Years for TEVAR Versus Open Surgery
Meta-analysis comparing death at 2 to 3 years for thoracic endovascular aortic repair (TEVAR) versus open surgery. The odds ratio (OR) for death from each included study is plotted. A pooled estimate of overall OR (diamonds) and 95% confidence intervals (width of diamonds) summarizes the effect size using the random effects model. Effects to the left of 1.0 favor TEVAR; effects to the right favor open surgery. When the horizontal bars of an individual study, or the pooled diamond width, cross 1.0, the effect is not significantly different. The I2 for heterogeneity was not significant, suggesting homogeneity in effect size across each study.
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Figure 5 Stroke for TEVAR Versus Open Surgery
Meta-analysis comparing stroke for thoracic endovascular aortic repair (TEVAR) versus open surgery. The odds ratio (OR) for stroke from each included study is plotted. A pooled estimate of overall OR (diamonds) and 95% confidence intervals (width of diamonds) summarizes the effect size using the random effects model. Effects to the left of 1.0 favor TEVAR; effects to the right favor open surgery. When the horizontal bars of an individual study, or the pooled diamond width, cross 1.0, the effect is not significantly different. The I2 for heterogeneity was not significant, suggesting homogeneity in effect size across each study.
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Figure 6 Paraplegia or Pareparesis for TEVAR Versus Open Surgery
Meta-analysis comparing paraplegia/pareparesis for thoracic endovascular aortic repair (TEVAR) versus open surgery. The odds ratio (OR) for paraplegia/pareparesis from each included study is plotted. A pooled estimate of overall OR (diamonds) and 95% confidence intervals (width of diamonds) summarizes the effect size using the random effects model. Effects to the left of 1.0 favor TEVAR; effects to the right favor open surgery. When the horizontal bars of an individual study, or the pooled diamond width, cross 1.0, the effect is not significantly different. The I2 for heterogeneity was not significant, suggesting homogeneity in effect size across each study.
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Figure 7 Metaregression for Death by Age Differences at Baseline
Metaregression of the effect of baseline age differences on the log odds ratio for the risk of death for thoracic endovascular aortic repair (TEVAR) versus open surgery. Each circle represents a study, telescoped by its weight in the analysis. The relationship was nonsignificant, suggesting that the impact of TEVAR on risk of death was consistent over the years (p = 0.13).
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Figure 8 Metaregression for Death at 30 Days by Enrollment Year
Metaregression of the effect of enrollment year on the log odds ratio for the risk of death at 30 days for thoracic endovascular aortic repair (TEVAR) versus open surgery. Each circle represents a study, telescoped by its weight in the analysis. The relationship was nonsignificant, suggesting that the impact of TEVAR on risk of death was consistent over the years (p = 0.45).
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Figure 9 Metaregression for Stroke by Enrollment Year
Metaregression of the effect of enrollment year on the log odds ratio for the risk of stroke for thoracic endovascular aortic repair (TEVAR) versus open surgery. Each circle represents a study, telescoped by its weight in the analysis. The relationship was nonsignificant, suggesting that the impact of TEVAR on risk of stroke was consistent over the years (p = 0.29).
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Figure 10 Metaregression for Paraplegia by Enrollment Year
Metaregression of the effect of enrollment year on the log odds ratio for the risk of paraplegia/pareparesis for thoracic endovascular aortic repair (TEVAR) versus open surgery. Each circle represents a study, telescoped by its weight in the analysis. The relationship did not reach significance, suggesting that the impact of TEVAR on risk of paraplegia/paraparesis was consistent over the years (p = 0.12).
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