Non-operative Management of Type A Acute Aortic Syndromes: A Systematic Review and Meta-Analysis

Abstract

Objective: For type A acute aortic syndrome (TAAAS), the only alternative for patients who are contraindicated for open surgery or endovascular interventions is medical therapy. The objective of this study was to assess the impact of conservative treatment in patients suffering TAAAS.

Methods: This systematic review and meta-analysis was performed according to the PRISMA guidelines. A systematic search was conducted on MEDLINE, Embase, and the Cochrane Library for relevant studies. Pairwise meta-analysis was conducted to compare surgical with medical intervention. Included studies were subjected to risk of bias assessment using the Newcastle-Ottawa scale.

Results: Twenty-nine studies comprising 6894 patients were included. For patients with type A aortic dissection (TAAD), the pooled proportions of all cause in hospital mortality and all cause 30 day mortality were 39.1% (95% confidence interval [CI] 29.8-48.9%; I² = 90.1%), and 31.1% (95% CI 8.8-59.1%; I² = 95.9%), respectively. There was a significant proportion of patients who converted from medical to surgical treatment (20.7%, 95% CI 0.0-61.7%; I² = 93.4%). In patients with type A intramural haematoma (IMH), the pooled proportions of all cause in hospital mortality and all cause 30 day mortality were 7.2% (95% CI 2.6-13.4%; I² = 76.5%) and 15.3% (95% CI 1.1-37.9%; I² = 64.1%). A significant proportion of patients converted from medical to surgical treatment (26.3%, 95% CI 12.1-43.4%; I² = 90.5%).

Conclusion: Mortality remains high for conservatively treated patients with TAAD. For patients with IMH, heterogeneity in the types of conservative treatment prohibit any firm conclusion regarding its safety and efficacy.

Keywords: Medical therapy; Surgery; Type A acute aortic syndrome; Type A aortic dissection; Type A intramural haematoma.