Open Surgical Versus Endovascular Repair for Type B Aortic Dissection: Umbrella Review and Meta-Analysis.

In 30 seconds

This umbrella review and meta-analysis compared thoracic endovascular aortic repair (TEVAR) with open surgical repair (OSR) for type B aortic dissection, synthesizing 11 systematic reviews identified through searches covering 2014–2025. TEVAR was associated with lower short-term mortality than OSR (risk ratio 0.51, 95% CI: 0.43-0.59; I² = 64.6%). Long-term survival was comparable. Findings also generally favored TEVAR for several complications, although results for stroke varied across reviews. The authors noted moderate to high heterogeneity in most outcomes and called for further high-quality longitudinal studies and randomized trials.

Key findings

• Short-term mortality favored TEVAR over OSR (risk ratio 0.51, 95% CI: 0.43-0.59; I² = 64.6%).
• Long-term survival was comparable between TEVAR and OSR.
• Stroke results were mixed across reviews, while pooled analysis favored TEVAR (RR: 0.67; 95% CI: 0.54-0.82; I² = 8.7%).
• Paraplegia rates were comparable (RR: 0.88; 95% CI: 0.53-1.47; I² = 22.7%).

Why it matters

The synthesis suggests that TEVAR may offer an early-outcome advantage over open repair, including lower short-term mortality and fewer reported complications, while long-term survival appears similar. These comparisons can inform understanding of the evidence base, but heterogeneity and the need for stronger longitudinal and randomized evidence limit certainty about comparative outcomes.

What to keep in mind

The review reports moderate to high heterogeneity among most studies (I² = 30%-64.6%) and identifies a need for higher-quality longitudinal studies and randomized controlled trials.