Following a systematic literature search, studies from 2008 to 2018 reporting outcomes of open repair of descending thoracic aortic aneurysms or thoracoabdominal aortic aneurysms were pooled in a single-arm meta-analysis performed using the generic inverse variance method. The primary outcome was operative mortality. Secondary outcomes were late mortality, and postoperative stroke, permanent and temporary spinal cord injury, renal failure, respiratory failure, and myocardial infarction.
Fifty-four studies with 12,245 patients were included. The pooled operative mortality for open repair was 10.4% (95% confidence interval (CI) 8.3-12.8): 6.6% (95%CI 3.7-11.6) for DTA and 10.5% (95%CI 7.5-14.5) for TAAA. The pooled incidence rate of late mortality was 0.6% (95%CI 0.5-0.8) per person-year. The pooled rates for postoperative outcomes were 4.9%(95%CI 3.9-6.1) for stroke, 5.7%(95%CI 4.3-7.5) and 3.0%(95%CI 2.1-4.2) for permanent and temporary spinal cord injury respectively, 13.2%(95%CI 9.9-17.3) for renal failure, 23.3%(95%CI 17.5-30.4) for respiratory failure, and 2.7%(95%CI 1.8-4.1) for myocardial infarction. At meta-regression, year of publication, use of the clamp-and-sew technique and use of the cerebrospinal fluid drain were associated with lower operative mortality. Ruptured aneurysms were associated with higher operative mortality.
Despite improvement, open repair of descending thoracic aortic aneurysms and thoracoabdominal aortic aneurysms continues to be associated with a considerable risk of operative death and perioperative complications. The use of the cerebrospinal fluid drain is associated with better outcomes.
Copyright © 2020. Published by Elsevier Inc.