title: Endovascular stent-graft placement or open surgery for the treatment of acute type B aortic dissection: a meta-analysis.
abstract: BACKGROUND
  Acute type B aortic dissection (ATBAD) is a life-threatening condition. Open chest surgical repair using a prosthetic graft has been a conventional treatment for ATBAD. During the past decade, thoracic endovascular aortic repair (TEVAR), which is considered as a less invasive and potentially safer technique, has been increasingly used to treat this condition. Evidence is needed to support the use of TEVAR for these patients. The aim of this review was to assess the efficacy of TEVAR versus conventional open surgery in patients with ATBAD.
  
  
  METHODS
  For this review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched: 2010, issue 4), MEDLINE, EMBASE, CINAHL, Web of Science, and the Chinese Biomedicine Database for clinical trials until January 18, 2011. Controlled trials in which patients with ATBAD were assigned to TEVAR or open surgical repair were included. For each outcome, we evaluated the quality of the evidence with reference to the Grading of Recommendations Assessments, Development, and Evaluation criteria. At the end, we used RevMan 5.0 software to analyze the datum.
  
  
  RESULTS
  Five trials (318 participants) are included in this review. As determined by the Grading of Recommendations Assessments, Development, and Evaluation approach, the result quality was low for 30-day mortality and very low for other variables. TEVAR can significantly reduce the short-term mortality for ATBAD (Mantel-Haenszel fixed odds ratio [95% confidence interval]: 0.19 [0.09-0.39], P < 0.001). TEVAR cannot significantly improve postoperative complications or long-term mortality.
  
  
  CONCLUSIONS
  TEVAR can be weakly recommended as an alternative for the selective treatment of ATBAD but cannot always be used in case of surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Wang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhou
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Hu
authors.forename: Hong-Bing
authors.initials: HB
authors.lastname: Wu
authors.forename: Yi
authors.initials: Y
authors.lastname: Guo
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D018849:Controlled Clinical Trials as Topic; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D011474:Prosthesis Design; D012042:Registries; D015607:Stents; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome