Since the optimal timing for thoracic endovascular aortic repair (TEVAR) in the context of type B aortic dissections (TBAD) remains an open question, we performed a systematic review with meta-analysis to evaluate outcomes of TEVAR according to the phases of TBAD – hyperacute, acute, subacute and chronic. We carried out a pooled meta-analysis of time-to-event data extracted from studies published by June 2023 for the following outcomes: all-cause mortality, aortic-related mortality, and late aortic reinterventions. Thirteen studies met our eligibility criteria, comprising 4,793 patients (10.3% hyperacute, 51.9% acute, 25.9% subacute, 11.9% chronic). Considering the overall population, we observed a statistically significant difference between the groups (Log-rank test, P<0.0001) and the main differences were found in the following comparisons: hyperacute versus acute (HR 1.61; 95%CI 1.21-2.13; P=0.001); hyperacute versus chronic (HR 1.70; 95%CI 1.17-2.46; P=0.005); subacute versus acute (HR 0.78; 95%CI 0.63-0.98; P=0.032). Considering the population with uncomplicated TBAD, we also observed a statistically significant difference for all-cause death between the groups (Log-rank test, P<0.0001) and the main differences were found in the comparisons for subacute versus acute (HR 0.72; 95%CI 0.58-0.88; P=0.002). Furthermore, we observed statistically significant differences between the groups for aortic-related death (Log-rank test, P<0.0001) and late aortic reintervention (Log-rank test, P<0.0001), all favoring mostly the subacute phase as the optimal timing for TEVAR. In conclusion, there seems to be a timing-specific difference in the outcomes of TEVAR for TBAD pointing to the subacute phase as the optimal timing to achieve better long-term outcomes.

由于 B 型主动脉夹层 (TBAD) 背景下胸主动脉腔内修复术 (TEVAR) 的最佳时机仍然是一个悬而未决的问题，我们进行了系统回顾和荟萃分析，根据 TBAD 的阶段评估 TEVAR 的结果 - 超急性期，急性，亚急性和慢性。我们对从 2023 年 6 月发表的研究中提取的事件发生时间数据进行了汇总荟萃分析，结果如下：全因死亡率、主动脉相关死亡率和晚期主动脉再干预。13 项研究符合我们的资格标准，包括 4,793 名患者（10.3% 超急性、51.9% 急性、25.9% 亚急性、11.9% 慢性）。考虑到总体人群，我们观察到各组之间存在统计学显着差异（对数秩检验，P<0.0001），主要差异在以下比较中发现：超急性与急性（HR 1.61；95%CI 1.21-2.13；P =0.001); 超急性与慢性（HR 1.70；95%CI 1.17-2.46；P=0.005）；亚急性与急性（HR 0.78；95%CI 0.63-0.98；P=0.032）。考虑到无并发症的 TBAD 人群，我们还观察到各组之间全因死亡存在统计学显着差异（对数秩检验，P<0.0001），主要差异发现于亚急性与急性的比较中（HR 0.72；95） %CI 0.58-0.88；P=0.002）。此外，我们观察到主动脉相关死亡（对数秩检验，P<0.0001）和晚期主动脉再干预（对数秩检验，P<0.0001）各组之间存在统计学显着差异，所有这些都倾向于将亚急性期作为最佳时机对于 TEVAR。总之，TEVAR 治疗 TBAD 的结果似乎存在时间特异性差异，表明亚急性期是实现更好长期结果的最佳时机。