Evidence map›Paper›PMID 40991360›Full record

ArticleInterdisciplinary cardiovascular and thoracic surgery2025

Endovascular vs. open surgical repair in retrograde type a dissection & intramural hematoma: A study-level meta-analysis.

Kelvin Jeason Yang, Nai-Hsin Chi, Hsi-Yu Yu, Yih-Sharng Chen, Chih-Hsien Wang, I-Hui Wu

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Article in Interdisciplinary cardiovascular and thoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

Single-stage total thoracoabdominal endovascular repair for acute non-A non-B aortic dissection with retrograde extension to the ascending aorta and concomitant abdominal dissecting aneurysm: a case report.Journal of cardiothoracic surgery · 2026
Article

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Kelvin Jeason YangDepartment of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.

Nai-Hsin ChiDepartment of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.

Hsi-Yu YuDepartment of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.

Yih-Sharng ChenDepartment of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.

Chih-Hsien WangDepartment of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.

I-Hui WuDepartment of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesRetrograde type A intramural haematoma (IMH) and aortic dissection are serious conditions requiring prompt surgical intervention. While open surgery is the traditional treatment, Thoracic Endovascular Aortic Repair (TEVAR) has emerged as a less invasive alternative. This meta-analysis compares the clinical outcomes of TEVAR versus open surgery for these conditions.

methodsA systematic review and study-level meta-analysis were conducted using study-level data extracted from published reports and analyzed using DerSimonian-Laird random-effects model, in line with the PRISMA guidelines. The study was prospectively registered with PROSPERO (registration ID: CRD42024594305). Databases including PubMed, Ovid MEDLINE, and EMBASE were searched for studies reporting outcomes on either open aortic repair or TEVAR for retrograde type A IMH/dissection that were published between 1st January 2000 and 31st March 2025. We included literatures that did not directly compare the two modalities and then pooled the event rates for comparison.

resultsThe meta-analysis included 24 studies-one comparative and 23 single-arm studies-with a total of 709 patients, comprising 259 who underwent open surgery and 450 who received TEVAR. The pooled in-hospital mortality was 3.9% (95% CI: 2.2-6.7; I 2 = 0.0%) for TEVAR and 12.5% (95% CI: 8.7-17.7; I 2 = 20.6%) for open surgery, showing a significant difference (logit event rate difference: -1.27; 95% CI: -1.94 to -0.60). TEVAR also showed fewer neurological complications, such as stroke and paraplegia (TEVAR: 4.1% [95% CI: 2.2 to 7.4]; I2 = 0.0% vs Open: 11.6% [95% CI: 7.6 to 17.2]; I2 = 30.9%), compared to open surgery. TEVAR also had a higher rate of false lumen thrombosis and IMH regression in the descending aorta (TEVAR: 97.4% [95% CI: 88.3 to 99.5]; I2 = 0% vs Open: 72.0% [95% CI: 51.5 to 86.2]; I2 = 50.8%). However, no significant differences were found in long-term mortality or the need for reintervention between the two groups.

conclusionsThis meta-analysis synthesizes current evidence for the use of TEVAR in retrograde type A IMH/dissection and use available information on open surgery as a reference. Our results suggested that TEVAR may be a safe and feasible alternative, with satisfactory short-term and long-term outcomes. Further large-scale studies are needed to clarify TEVAR's role and its efficacy against open surgery.

Indexed as

Aortic dissectionIntramural haematomaopen aortic repairThoracic endovascular aortic repair

Identifiers

PMID40991360

DOI10.1093/icvts/ivaf224

PMCPMC12517338

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LicenceCC BY-NC

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