Thirty-nine studies (609 patients with AD) were included in the review; the studies appeared to be observational case series.
Procedural data and in-hospital course.
Procedural success (n=551) occurred in 98.2 +/- 0.5% of patients. Emergency surgical conversion (n=609) was required in 1.1 +/- 0.4% and elective surgical conversion was performed in a further 1.2 +/- 0.4%. In-hospital complications (n=449) were reported in 13.6 +/- 1.5% of patients (worse-case estimate 17.6 +/- 1.4%). Most were of major clinical significance (n=449) (11.1 +/- 1.4%; worse-case estimate 10.2 +/- 1.2%), including those related to retrograde extension of the dissection into the descending aorta (n=429; 1.9 +/- 0.6%) and neurologic complications (n=518; 2.9 +/- 0.7%; worse-case estimate 3.4 +/- 0.7%); stroke (n=518) occurred in 1.9 +/- 0.6% (worse-case estimate 2.6 +/- 0.6%) and paraplegia (n=609) in 0.8% +/- 0.4%. Minor complications (n=449) were less frequent (2.5 +/- 0.7%; worse-case estimate 7.4 +/- 0.9%).
Overall in-hospital mortality (n=524) was 5.2 +/- 0.9% (worse-case estimate 6.2 +/- 0.9%) and 30-day mortality (n=524) was 5.3 +/- 0.9% (worse-case estimate 4.1 +/- 0.9%).
Follow-up data.
The total re-intervention rate was 11.9 +/- 0.2% over a period of 19.5 +/- 7.1 months, including the index hospitalisation. All-cause mortality (n=609) was 2.8 +/- 0.7% (worse-case estimate 4.1 +/- 0.9%). Survival rates were 93.3 +/- 1.4% at 30 days, 90.6 +/- 1.6% at 6 months, 89.9 +/- 1.7% at 1 year, and 88.8 +/- 1.9% at 2 years.
Influence of publication date.
Technical success rates were lower in earlier studies (i.e. those published from 1999 to 2001) in comparison with later studies (i.e. those published from 2002 to 2004). However, overall complications and neurological complication rates were higher in the more recently published studies. No differences were observed in operative or 1-year mortality rates.
Influence of operator experience.
More experienced centres (i.e. with a total number of patients above the median) performed better than less experienced centres (i.e. with a total number of patients below the median).
Acute versus chronic AD.
Acute AD patients were significantly younger. In-hospital complications were significantly more common in acute AD than in chronic AD patients (21.7% versus 9.1, P=0.005). Major complications (14.5% versus 7.9%, P=0.124) and 30-day mortality (9.8% versus 3.2%, P=0.015) were also greater in acute AD than in chronic AD, but not significantly. Survival rates failed to differ between the two groups after 1 year (P=0.088).