{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T12:36:38Z","timestamp":1793795798264,"version":"4.6.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Good Liver Foundation"},{"name":"National Taiwan University, College of Medicine"},{"name":"Department of Surgery, National Taiwan University Hospital"},{"name":"Taiwanese Society of Phlebology"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Retrograde type A intramural haematoma (IMH) and aortic dissection are serious conditions requiring prompt surgical intervention. Although 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A systematic review and study-level meta-analysis were conducted using study-level data extracted from published reports and analysed using the DerSimonian and Laird random-effects model, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The study was prospectively registered with PROSPERO (registration ID: CRD42024594305). Databases including PubMed, Ovid MEDLINE, and EMBASE, Cochrane Library were searched for studies reporting outcomes on either open aortic repair or TEVAR for retrograde type A IMH\/dissection that were published between 1 January 2000 and 31 March 2025. We included articles that did not directly compare the 2 modalities and then pooled the event rates for comparison.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The meta-analysis included 24 studies\u20141 comparative and 23 single-arm studies\u2014with 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; I2 = 0.0%) for TEVAR and 12.5% (95% CI: 8.7-17.7; I2 = 20.6%) for open surgery, showing a significant difference (logit event rate difference: \u22121.27; 95% CI: \u22121.94 to \u22120.60). TEVAR also showed fewer neurologic complications, such as stroke and paraplegia (TEVAR: 4.1% [95% CI: 2.2-7.4]; I2 = 0.0% vs open surgery: 11.6% [95% CI: 7.6-17.2]; 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: 88.3-99.5]; I2 = 0% vs open susrgery: 72.0% [95% CI: 51.5-86.2]; I2 = 50.8%). However, no significant differences were found in long-term mortality or in the need for reintervention between the 2 groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This meta-analysis synthesizes current evidence for the use of TEVAR in retrograde type A IMH\/dissection and uses available information on open surgery as a reference. Our results suggested that TEVAR may be a safe and feasible alternative, with satisfactory short- and long-term outcomes. Further large-scale studies are needed to clarify TEVAR\u2019s role and its efficacy compared with open surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical registration number<\/jats:title>\n                  <jats:p>This systemic review\/meta-analysis was registered with PROSPERO (registration number: CRD42024594305)<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf224","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T15:53:35Z","timestamp":1758729215000},"source":"Crossref","is-referenced-by-count":2,"title":["Endovascular Versus Open Surgical Repair in Retrograde Type A Dissection and Intramural Haematoma: A Study-Level Meta-Analysis"],"prefix":"10.1093","volume":"40","author":[{"given":"Kelvin Jeason","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Taipei Tzu-Chi Hospital , New Taipei City, 231,","place":["Taiwan"]},{"name":"School of Medicine, Tzu Chi University , Hualien, 970,","place":["Taiwan"]},{"name":"Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University , Taipei, 100225,","place":["Taiwan"]},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University , Taipei, 10051,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nai-Hsin","family":"Chi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University , Taipei, 100225,","place":["Taiwan"]},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University , Taipei, 10051,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsi-Yu","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University , Taipei, 100225,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yih-Sharng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University , Taipei, 100225,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3214-6867","authenticated-orcid":false,"given":"Chih-Hsien","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University , Taipei, 100225,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4367-9108","authenticated-orcid":false,"given":"I-Hui","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University , Taipei, 100225,","place":["Taiwan"]},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University , Taipei, 10051,","place":["Taiwan"]},{"name":"Department of Traumatology, National Taiwan University Hospital , Taipei, 100225,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"2025101313113928500_ivaf224-B1","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1093\/eurheartj\/ehx319","article-title":"Acute aortic syndromes: diagnosis and management, an update","volume":"39","author":"Bossone","year":"2018","journal-title":"Eur Heart J"},{"key":"2025101313113928500_ivaf224-B2","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1007\/s00059-011-3501-0","article-title":"Aortic intramural hematoma: aspects of pathogenesis 2011","volume":"36","author":"Song","year":"2011","journal-title":"Herz"},{"key":"2025101313113928500_ivaf224-B3","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1161\/CIRCULATIONAHA.109.907246","article-title":"Is the optimal management of acute type A aortic intramural hematoma evolving?","volume":"120","author":"Evangelista","year":"2009","journal-title":"Circulation"},{"key":"2025101313113928500_ivaf224-B4","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.jtcvs.2015.09.055","article-title":"Preoperative characteristics and surgical outcomes of acute intramural hematoma involving the ascending aorta: a propensity score-matched analysis","volume":"151","author":"Matsushita","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025101313113928500_ivaf224-B5","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J"},{"key":"2025101313113928500_ivaf224-B6","doi-asserted-by":"crossref","first-page":"e182","DOI":"10.1016\/j.jtcvs.2023.04.023","article-title":"2022 ACC\/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"166","author":"Isselbacher","year":"2023","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025101313113928500_ivaf224-B7","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.004649","article-title":"Retrograde type A aortic dissection after thoracic endovascular aortic repair: a systematic review and meta-analysis","volume":"6","author":"Chen","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2025101313113928500_ivaf224-B8","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1161\/01.CIR.0000087009.16755.E4","article-title":"Aortic dissection: new frontiers in diagnosis and management: part I: from etiology to diagnostic strategies","volume":"108","author":"Nienaber","year":"2003","journal-title":"Circulation"},{"key":"2025101313113928500_ivaf224-B9","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1161\/01.CIR.0000023453.90533.82","article-title":"Intramural hematoma in acute aortic syndrome: more than one variant of dissection?","volume":"106","author":"Nienaber","year":"2002","journal-title":"Circulation"},{"key":"2025101313113928500_ivaf224-B10","doi-asserted-by":"crossref","first-page":"4250","DOI":"10.21037\/jtd-21-574","article-title":"Endovascular repair for retrograde type A intramural hematoma with focal intimal disruption in descending aorta","volume":"13","author":"Li","year":"2021","journal-title":"J Thorac Dis"},{"key":"2025101313113928500_ivaf224-B11","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1007\/s11748-020-01397-0","article-title":"Thoracic endovascular repair for retrograde acute type A aortic dissection as an alternative choice","volume":"68","author":"Omura","year":"2020","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"2025101313113928500_ivaf224-B12","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.ejvs.2020.05.021","article-title":"Endovascular repair for retrograde type A intramural haematoma with intimal tear in the descending thoracic aorta","volume":"60","author":"Ryoi","year":"2020","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2025101313113928500_ivaf224-B13","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.jvir.2011.12.023","article-title":"Thoracic endovascular aortic repair for retrograde type A aortic dissection with an entry tear in the descending aorta","volume":"23","author":"Shu","year":"2012","journal-title":"J Vasc Interv Radiol"},{"key":"2025101313113928500_ivaf224-B14","doi-asserted-by":"crossref","first-page":"755214","DOI":"10.3389\/fcvm.2021.755214","article-title":"Outcome comparison between open and endovascular aortic repair for retrograde type A intramural hematoma with intimal tear in the descending thoracic aorta: a retrospective observational study","volume":"8","author":"Yang","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"2025101313113928500_ivaf224-B15","doi-asserted-by":"crossref","first-page":"105906","DOI":"10.1016\/j.ijsu.2021.105906","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"88","author":"Page","year":"2021","journal-title":"Int J Surg"},{"key":"2025101313113928500_ivaf224-B16","doi-asserted-by":"crossref","first-page":"j4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"key":"2025101313113928500_ivaf224-B17","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"2025101313113928500_ivaf224-B18","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/j.jvs.2019.11.013","article-title":"Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections","volume":"71","author":"Lombardi","year":"2020","journal-title":"J Vasc Surg"},{"key":"2025101313113928500_ivaf224-B19","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1093\/ejcts\/ezaa329","article-title":"Efficacy of entry exclusion strategy for DeBakey type III retrograde Stanford type A acute aortic dissection","volume":"59","author":"Inoue","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025101313113928500_ivaf224-B20","doi-asserted-by":"crossref","DOI":"10.1093\/icvts\/ivac264","article-title":"Retrograde type A aortic dissection: a different evil","volume":"35","author":"Lopez-Marco","year":"2022","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2025101313113928500_ivaf224-B21","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S0022-5223(19)34835-4","article-title":"Surgery for acute dissection of ascending aorta","volume":"104","author":"Crawford","year":"1992","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025101313113928500_ivaf224-B22","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1067\/mva.2001.118808","article-title":"Transluminal placement of endovascular stent-grafts for the treatment of type A aortic dissection with an entry tear in the descending thoracic aorta","volume":"34","author":"Kato","year":"2001","journal-title":"J Vasc Surg"},{"key":"2025101313113928500_ivaf224-B23","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S0022-5223(96)70097-1","article-title":"Extended aortic replacement for acute type a dissection with the tear in the descending aorta","volume":"112","author":"Kazui","year":"1996","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025101313113928500_ivaf224-B24","doi-asserted-by":"crossref","first-page":"524","DOI":"10.21037\/acs.2019.07.08","article-title":"Optimal timing of type A intramural hematoma repair","volume":"8","author":"Al Rstum","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"2025101313113928500_ivaf224-B25","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1056\/NEJM199905203402003","article-title":"Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement","volume":"340","author":"Nienaber","year":"1999","journal-title":"N Engl J Med"},{"key":"2025101313113928500_ivaf224-B26","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1016\/j.jvir.2020.01.017","article-title":"Thoracic endovascular aortic repair for type B aortic dissection associated with retrograde type A intramural hematoma","volume":"31","author":"Li","year":"2020","journal-title":"J Vasc Interv Radiol"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivaf224\/64373733\/ivaf224.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/10\/ivaf224\/64373733\/ivaf224.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/10\/ivaf224\/64373733\/ivaf224.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T17:11:49Z","timestamp":1760375509000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivaf224\/8262966"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,24]]},"references-count":26,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10,6]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivaf224","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,10]]},"published":{"date-parts":[[2025,9,24]]},"article-number":"ivaf224"}}