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Meta-Analysis
. 2023 Aug 20;29(4):177-184.
doi: 10.5761/atcs.ra.22-00219. Epub 2023 Feb 16.

Thoracic Endovascular Aortic Repair versus Optimal Medical Treatment in Patients with Type B Intramural Hematoma: A Meta-Analysis

Jingyuan Li  1   2 , Xiaoyu Qu  2 , Xiu Jia  2 , Yinghui Gong  2 , Tienan Zhou  2 , Xiaozeng Wang  1   2
Affiliations
Meta-Analysis

Thoracic Endovascular Aortic Repair versus Optimal Medical Treatment in Patients with Type B Intramural Hematoma: A Meta-Analysis

Jingyuan Li et al. Ann Thorac Cardiovasc Surg. .

Abstract

Purpose: We intended to study the effect of thoracic endovascular aortic repair (TEVAR) and optimal medical treatment (OMT) on type B intramural hematoma (BIMH).

Methods: We searched PubMed, EMbase, Cochrane Library, and China National Knowledge Infrastructure databases that compared TEVAR and OMT in patients with BIMH. Two authors independently assessed the risk of bias using the Newcastle-Ottawa Scale. The rate ratio (RR) and 95% confidence interval were used to calculate the outcome. The primary endpoints were aortic-related death and regression/resolution. Secondary endpoints were all-cause death, progression to dissection, and secondary intervention.

Results: Eight observational studies were included in the analysis. TEVAR reduced aortic-related death (RR 0.22, 95% CI 0.08-0.56, P = 0.002, I² = 24%) and promoted hematoma regression/resolution (RR 1.48, 95% CI 1.05-2.10, P <0.05, I² = 71%) compared to OMT. Moreover, TEVAR was associated with a reduction in progression to dissection (RR 0.32, 95% CI 0.13-0.81, P <0.02, I² = 39%) and secondary intervention (RR 0.18, 95% CI 0.09-0.37, P <0.00001, I² = 38%) compared to OMT. However, all-cause death has no significant difference between the two groups (RR 0.45, 95% CI 0.17-1.19, P = 0.11, I² = 58%).

Conclusions: The results of this meta-analysis suggested that TEVAR is an effective treatment for BIMH, which can delay the progression of intramural hematoma and promotes regression/resolution. More research about indications of TEVAR is still needed.

Keywords: meta-analysis; optimal medical treatment; thoracic endovascular aortic repair; type B intramural hematoma.

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Conflict of interest statement

All authors declared no relevant conflict of interest.

Figures

Fig. 1
Fig. 1. Study selection. BIMH: type B intramural hematoma; TEVAR: thoracic endovascular aortic repair; MT: medical treatment
Fig. 2
Fig. 2. Pooled analyses of TEVAR versus OMT for the primary endpoints of aortic-related death. TEVAR: thoracic endovascular aortic repair; OMT: optimal medical treatment; CI: confidence interval; df: degrees of freedom; M–H: Mantel–Haenszel
Fig. 3
Fig. 3. Pooled analyses of TEVAR versus OMT for the primary endpoints of regression/resolution. TEVAR: thoracic endovascular aortic repair; OMT: optimal medical treatment; CI: confidence interval; df: degrees of freedom; M–H: Mantel–Haenszel
Fig. 4
Fig. 4. Pooled analyses of TEVAR versus OMT for the secondary endpoints of all-cause death. TEVAR: thoracic endovascular aortic repair; OMT: optimal medical treatment; CI: confidence interval; df: degrees of freedom; M–H: Mantel–Haenszel
Fig. 5
Fig. 5. Pooled analyses of TEVAR versus OMT for the secondary endpoints of progression to dissection. TEVAR: thoracic endovascular aortic repair; OMT: optimal medical treatment; CI: confidence interval; df: degrees of freedom; M–H: Mantel–Haenszel
Fig. 6
Fig. 6. Pooled analyses of TEVAR versus OMT for the secondary endpoints of secondary intervention. TEVAR: thoracic endovascular aortic repair; OMT: optimal medical treatment; CI: confidence interval; df: degrees of freedom; M–H: Mantel–Haenszel
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