JACC: TEVAR shows promise over surgery for aortic disease

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Current data from nonrandomized studies suggest that thoracic endovascular aortic repair (TEVAR) may reduce early death, paraplegia, renal insufficiency, transfusions, reoperation for bleeding, cardiac complications, pneumonia and length of stay compared with open surgery, according to a meta-analysis published online Feb. 3 in the Journal of the American College of Cardiology. Yet, the authors noted that “sustained benefits on survival have not been proven.”

Davy Cheng, MD, from the anesthesia and peri-operative medicine unit at the University of Western Ontario in London, Ontario, and colleagues performed a metaregression to account for baseline risk factor imbalances, study design and thoracic pathology. Due to significant heterogeneity, the researchers analyzed registry data separately from comparative studies.

Cheng and colleagues included nonrandomized studies involving 5,888 patients (38 comparative studies, four registries). They balanced patient characteristics except for age, as TEVAR patients were usually older than open surgery patients.

The researchers found that registry data suggested overall periperative complications were reduced. In comparative studies, all-cause mortality at 30 days (odds ratio [OR]: 0.44) and paraplegia (OR: 0.42) were reduced for TEVAR versus open surgery.

In addition, the authors reported that cardiac complications, transfusions, reoperation for bleeding, renal dysfunction, pneumonia and length of stay were reduced for TEVAR. “There was no significant difference in stroke, MI, aortic reintervention and mortality beyond one year,” they wrote.

Since there was generally low heterogeneity across trials, “this lends credence to the robustness of the results across studies,” according to the authors.

“Although it remains an important caveat that these conclusions are based on observational comparative studies, the consistency of results across aortic pathologies, baseline age groups and time periods of patient recruitment increases confidence that the findings are robust. Nonetheless, randomized trials are required to confirm the results of this metaregression,” Cheng and colleagues concluded.

“Any future randomized trials should be encouraged to adhere to the guidelines for reporting studies of TEVAR," they wrote, "and will need to address clinically important gaps in the existing evidence base, including whether longer-term survival, stroke risk, need for reintervention, quality of life, and patient functionality are improved, and whether the cost-effectiveness warrants broader uptake of TEVAR in place of open surgery.”