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Updated: Nov 17, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Systematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection
Simon De Freitas1, Matthew J Rossi1, Steven D Abramowitz1
1MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
Insights
Endovascular repair of ascending aorta dissections is a feasible alternative for high-risk patients. This meta-analysis shows acceptable safety but requires clinical trials before routine use.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Open repair is standard for Stanford type A aortic dissection but is declined in up to 25% of patients due to prohibitive risk.
- Nonoperative management of aortic dissection carries an unacceptably high mortality rate.
- Endovascular repair of the ascending aorta is an emerging alternative for select patients.
Purpose of the Study:
- To systematically review and report outcomes for acute type A aortic dissections treated with endovascular repair.
- To evaluate the safety and efficacy of endovascular approaches in a high-risk surgical population.
Main Methods:
- Systematic review and meta-analysis conducted per PRISMA guidelines.
- Literature search of online databases through April 2020.
- Meta-analysis of data from 14 studies including 80 cases (55 acute, 25 subacute) on technical success, mortality, stroke, and reintervention.
Main Results:
- Estimated outcomes rates: 17% mortality, 15% technical failure, 11% stroke, 18% reintervention.
- Significant variation in techniques and device designs across studies.
- Mean study quality score (Downs and Black) was 13.9 ± 3.2.
Conclusions:
- Endovascular repair of type A aortic dissection is a feasible and reproducible technique.
- The meta-analysis indicates an acceptable safety profile for inoperable patients with poor prognosis.
- Further data from clinical trials are necessary before routine clinical adoption.
Objective:
The standard surgical approach to Stanford type A aortic dissection is open repair. However, up to one in four patients will be declined surgery because of prohibitive risk. Patients who are treated nonoperatively have an unacceptably high mortality. Endovascular repair of the ascending aorta is emerging as an alternative treatment for a select group of patients. The reported rates of technical success, mortality, stroke, and reintervention have varied. The objective of the study was to systematically report outcomes for acute type A dissections repaired using an endovascular approach.
Methods:
The systematic review and meta-analysis was conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. We performed online literature database searches through April 2020. The demographic and procedural characteristics of the individual studies were tabulated. Data on technical success, short-term mortality, stroke, and reintervention were extracted and underwent meta-analysis using a random effects model.
Results:
Fourteen studies with 80 cases of aortic dissection (55 acute and 25 subacute) were included in the final analysis. A wide variation was found in technique and device design across the studies. The outcomes rates were estimated at 17% (95% confidence interval [CI], 10%-26%) for mortality, 15% (95% CI, 8%-23%) for technical failure, 11% (95% CI, 6%-19%) for stroke and 18% (95% CI, 9%-31%) for reintervention. The mean Downs and Black quality assessment score was 13.9 ± 3.2.
Conclusions:
The technique for endovascular repair of type A aortic dissection is feasible and reproducible. The results of our meta-analysis demonstrate an acceptable safety profile for inoperable patients who otherwise would have an extremely poor prognosis. Data from clinical trials are required before the technique can be introduced into routine clinical practice.
