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Meta-Analysis
. 2023 Dec 12;59(12):2150.
doi: 10.3390/medicina59122150.

The Rate of Postoperative Complications in Complicated Acute, and Subacute Type B Aortic Dissections after TEVAR vs. PETTICOAT Procedures: Systematic Review and Meta-Analysis

Natalia Niklas  1 , Klaudia Królikowska  1 , Kinga Zdrodowska  1 , Piotr Gutowski  1 , Arkadiusz Kazimierczak  1 , Paweł Rynio  1
Affiliations
Meta-Analysis

The Rate of Postoperative Complications in Complicated Acute, and Subacute Type B Aortic Dissections after TEVAR vs. PETTICOAT Procedures: Systematic Review and Meta-Analysis

Natalia Niklas et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Provisional extension to induce complete attachment (PETTICOAT) is suggested as being associated with a lower incidence of aorta-related events and fewer reinterventions compared to thoracic endovascular aortic repair (TEVAR) in patients with complicated acute, and subacute type B aortic dissections. Materials and Methods: This article is a systematic review and meta-analysis following the PRISMA guidelines. The Medline, PubMed, Embase, and Cochrane databases were searched, starting on 21 February 2022 and ending on 22 June 2022, to identify studies that investigated the rate of postoperative complications in patients treated with the PETTICOAT compared to the TEVAR. A random effects meta-analysis was performed. Of 2350 studies, 5 studies involving 360 patients were included: 143 patients after the PETTICOAT procedure and 217 after the TEVAR. Results: The meta-analysis of all studies showed that the rate of secondary endovascular reinterventions was smaller in patients treated with the PETTICOAT (n = 3 studies; OR, 0.30; 95% CI, 0.10 to 0.94; p = 0.04). The results of other postoperative complications (30-day mortality, mortality during follow-up, paraplegia, stroke, and occurrence of endoleak) were lower in the PETTICOAT group but were not statistically significant. The rate of postoperative renal failure was lower in patients treated with the TEVAR (n = 4; OR, 1.08; 95% CI, 0.46 to 2.51; p = 0.86). Conclusion: This meta-analysis suggests that the PETTICOAT procedure is related to the lower rate of secondary endovascular reinterventions for complicated acute, and subacute type B aortic dissections.

Keywords: PETTICOAT; TEVAR with bare metal stent; endovascular reinterventions.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Grading of Recommendations, Assessment, Development, and Evaluations (GRADE score) for each outcome.
Figure 2
Figure 2
PRISMA 2020 flow diagram for new systematic reviews including only searches of databases only. PRISMA, preferred reporting items for systematic reviews and meta-analyses.
Figure 3
Figure 3
Association between implantation of the TEVAR with a bare metal stent and the rate of endovascular reinterventions, with the rate of bias calculated according to the ROBINS-I guidelines. On the right side of the figure, the green color represents a low risk of calculated bias and the red a moderate risk of bias [2,3,21]. The horizontal lines represent 95% confidence intervals (CIs). N, number of patients; OR, odds ratio; and SE, standard error.
Figure 4
Figure 4
Leave-one-out analysis for the rate of endovascular reinterventions [2,3,21].
Figure 5
Figure 5
Leave-one-out meta-analysis with random effect and change in precision for the rate of endovascular reinterventions [2,3,21].
Figure 6
Figure 6
Association between implantation of the TEVAR with a bare metal stent and the rate of surgical reinterventions, with risk of bias calculated according to the ROBINS-I guidelines. On the right side of the figure, the green color represents a low risk of calculated bias and the red a moderate risk of bias [2,3,21]. The horizontal lines represent 95% confidence intervals (CIs). N, number of patients; OR, odds ratio; and SE, standard error.
Figure 7
Figure 7
Leave-one-out analysis for the rate of surgical reinterventions [2,3,21].
Figure 8
Figure 8
Association between implantation of the TEVAR with a bare metal stent and the rate of postoperative stroke, with the risk of bias calculated according to the ROBINS-I guidelines. On the right side of the figure, the green color represents a low risk of calculated bias and the red a moderate risk of bias [2,3,9,21]. The horizontal lines represents 95% confidence intervals (CI). N, number of patients; OR, odds ratio; and SE, standard error.
Figure 9
Figure 9
Association between implantation of the TEVAR with a bare metal stent and the rate of paraplegia with the risk of bias calculated according to the ROBINS-I guidelines. On the right side of the figure, the green color represents a low risk of calculated bias and the red a moderate risk of bias [2,3,9,21]. The horizontal lines represents 95% confidence intervals (Cis). N, number of patients; OR, odds ratio; and SE, standard error.
Figure 10
Figure 10
Association between implantation of the TEVAR with a bare metal stent and the occurrence of postoperative endoleak, with the risk of bias calculated for the cohort studies (ROBINS-I) and randomized controlled study (RCT) (RoB2). On the right side of the figure, the green color represents a low risk of calculated bias and the red a moderate risk of bias [3,21,22]. The horizontal line represents 95% confidence intervals (CI). N, number of patients; OR, odds ratio; and SE, standard error.
Figure 11
Figure 11
Association between implantation of the TEVAR and postoperative renal failure, with the risk of bias calculated according to the ROBINS-I guidelines. On the right side of the figure, the green color represents a low risk of calculated bias and the red a moderate risk of bias [2,3,9,21]. The horizontal lines represents 95% confidence intervals (CI). N, number of patients; OR, odds ratio; and SE, standard error.
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