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J Thorac Cardiovasc Surg 2009;138:865-872
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Endovascular stent graft placement in patients with type B aortic dissection: A meta-analysis in China

^a Department of Vascular Surgery, Clinical Division of Surgery, Chinese PLA General Hospital, Beijing, China
^b Division of Cardiology, University of Washington, Seattle, Wash
^c Department of Vascular Surgery, Institute of Vascular Surgery, The First Affiliated Hospital, Sun Yet-sen University, Guangzhou, China
^d Department of Statistics, Chinese PLA General Hospital, Beijing, China

Received for publication June 3, 2008; revisions received December 23, 2008; accepted for publication February 2, 2009.

^_* Address for reprints: Jiang Xiong, PhD, MD, Department of Vascular Surgery, Institute of Vascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, China PR, 100852. (Email: xiongjiangdoc{at}126.com).

Objective: We summarized all published studies for endovascular stent graft placement among patients with type B aortic dissection in China with respect to clinical success, complications, and outcomes.

Methods: A meta-analysis was performed on all published studies of retrograde endovascular stent graft placement encompassing 3 or more patients with type B aortic dissection. Thirty-nine studies, involving a total of 1304 patients from January 2001 to December 2007, were included.

Results: The average patient age was 52 years. Procedural success was reported in 99.2% ± 0.1% of patients. Major complications were reported in 3.4% ± 0.1% patients, with the most severe neurologic complications in 0.6%. Periprocedural stroke was encountered more frequently than paraplegia (0.2% vs 0%). The overall 30-day mortality was 2.6% ± 0.1%. In addition, 1.5% ± 0.1% of patients died over a mean follow-up period of 27.1 ± 17.5 months. Life-table analysis yielded overall survival rates of 96.9% at 30 days, 96.7% at 6 months, 96.4% at 1 year, 95.6% at 2 years, and 95.2% at 5 years.

Conclusion: Although therapy with traditional medicines still remains the first line of treatment for type B aortic dissection, endovascular stent graft placement has shown its advantages, with a success rate of 99% or greater in a select cohort. The technical survival rate, major complications, and acute and midterm survival rates in the Chinese-language literature appeared to favorably compare with that seen in published literature. This analysis is the first to provide an overview of the currently available literature on endovascular stent graft placement in type B aortic dissection in China.