NEW YORK (Reuters Health) – Endovascular surgery on the descending thoracic aorta offers many advantages over open surgery, including fewer complications, a reduced risk of early mortality and a shorter hospital stay, the results of a meta-analysis suggest.

Whether the short-term benefits of thoracic endovascular repair (TEVAR) translate into long-term improvements in survival, however, is not yet clear, according to lead author Dr. Davy Cheng, from London Health Sciences Center, Ontario, Canada, and his colleagues.

The researchers found no survival advantage for TEVAR beyond 1 year, but they emphasize that no definitive conclusions can be drawn since the two approaches have not been compared in randomized trials.

Their analysis included 38 comparative studies and 4 registry reports involving a total of 5888 patients. Aside from TEVAR patients typically being older than open repair patients (p = 0.001), the characteristics of the two groups were generally similar, according to the report in the February 3rd online issue of the Journal of the American College of Cardiology.

Analysis of the registry data suggested that use of TEVAR rather than open repair reduces overall perioperative complications.

In the comparative study analysis, TEVAR reduced the risk of all-cause mortality at 30 days and paraplegia by 56% and 58%, respectively, relative to open repair. Additionally, TEVAR reduced transfusions, reoperations for bleeding, renal dysfunction, pneumonia, and hospital length of stay.

By contrast, there were no significant differences between TEVAR and open repair in rates of stroke, myocardial infarction, aortic reintervention, or mortality beyond 1 year.

With regard to their findings that TEVAR may reduce early mortality and paraplegia risks – along with other serious complications – the authors write, “Although it remains an important caveat that these conclusions are based on observational comparative studies, the consistency of results across aortic pathologies, baseline age groups, and time periods of patient recruitment increases confidence that the findings are robust.”

They add that “any future randomized trials…will need to address clinically important gaps in the existing evidence base, including whether longer term survival, stroke risk, need for reintervention, quality of life, and patient functionality are improved, and whether the cost-effectiveness warrants broader uptake of TEVAR in place of open surgery.”

Reference:
J Am Coll Cardiol 2010.