Incidence of mortality and surgical reintervention following thoracic endovascular aortic repair for uncomplicated type B aortic dissection
Notice bibliographique
Résumé
Background Uncomplicated type B aortic dissection (uTBAD) is primarily managed through optimal medical therapy, whereas complicated cases typically require thoracic endovascular aortic repair (TEVAR). There are published data that suggest that patients managed long-term with optimal medical therapy have an increased likelihood of requiring crossover TEVAR in the emergent acute setting, which are generally associated with poorer outcomes when compared with the nonacute setting. These findings raise consideration for whether TEVAR may be used for patient populations that remain asymptomatic to prevent these delayed acute encounters. This systematic review aims to evaluate mortality, surgical reintervention, and adverse outcomes after TEVAR in patients with uTBAD, stratified by timing of intervention. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE and Embase for studies on TEVAR outcome data for uTBAD published between 2014 and 2024. Eligible studies reported 30-day or 1-year incidence of mortality, surgical reintervention, and/or adverse events after TEVAR, with data stratified by intervention timing. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool, and evidence quality was evaluated using a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results Eleven studies from a screen of 2308 were included, comprising retrospective cohort analyses of 70 to 1536 patients. Acute-phase TEVAR demonstrated 30-day mortality rates ranging from 0.5% to 7.5%, compared with 0.0% to 2.7% in the subacute phase and 1.6% to 2.4% in the chronic phase. One-year mortality ranged from 4.7% to 15.7% in acute interventions and up to 8.2% in subacute interventions, with no data for chronic cases. Reintervention rates were higher in acute-phase TEVAR, ranging from 0.8% to 11.4%, compared with 0.7% to 6.8% in the subacute phase. Adverse outcomes, including endoleak, stroke, and retrograde type A aortic dissection, were more frequent in acute-phase interventions. Conclusions Subacute-phase TEVAR appears to offer optimal outcomes in patients with uTBAD, balancing the risks of acute hemodynamic instability and challenges of chronic anatomical changes. Although emerging evidence supports earlier intervention, high-quality contemporary studies are needed to refine patient selection and intervention timing. Furthermore, there are limited consistent end points for long-term outcome data, which is necessary to improve on treatment guidelines.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».