Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2025; 17(8): 109738
Published online Aug 26, 2025. doi: 10.4330/wjc.v17.i8.109738
Sex-based outcomes following thoracic endovascular aortic repair for acute complicated type B aortic dissection: A meta-analysis
Muneeb Khawar, Syed Abdullah Shah, Aqsa Komel, Zainab Anfaal, Umad Ali, Moosa Mubarik, Muhammad Khan Buhadur Ali, Awon Muhammad, Muneeb Saifullah, Mirza Muhammad Hadeed Khawar, Abdul Qadeer, Saad Ur Rahman, Mobeen Haider, Abbas Muhammad Mehdi
Muneeb Khawar, Syed Abdullah Shah, Umad Ali, Awon Muhammad, Muneeb Saifullah, Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Aqsa Komel, Moosa Mubarik, Department of Medicine, Nishtar Medical University, Multan 66000, Punjab, Pakistan
Zainab Anfaal, Department of Medicine, Khyber Medical College, Peshawar 25120, Khyber Pakhtunkhwa, Pakistan
Muhammad Khan Buhadur Ali, Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Mirza Muhammad Hadeed Khawar, Department of Medicine, Services Institute of Medical Sciences, Lahore 54000, Punjab, Pakistan
Abdul Qadeer, Department of Medicine, Mayo Clinic Phoenix, Arizona, AZ 5777 E, United States
Saad Ur Rahman, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
Mobeen Haider, Department of Medicine, West Virginia University, Morgantown, WV 26506, United States
Abbas Muhammad Mehdi, Department of Medicine, International School of Medicine, International University of Kyrgyzstan, Bishkek 720065, Kyrgyzstan
Author contributions: Khawar M, Shah SA, Komel A lead conceptualization, methodology and formal analysis and wrote and reviewed the manuscript; Anfaal Z, Ali U, Mubarik M, Ali MKB, Muhammad A lead software, validation, investigation and wrote and reviewed the manuscript; Saifullah M, Khawar MMH, Qadeer A, Rehman SU, Haider M and Mehdi AM wrote and reviewed the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abbas Muhammad Mehdi, MD, Department of Medicine, International School of Medicine, International University of Kyrgyzstan, 6 Seven April Street, Bishkek 720065, Kyrgyzstan. malikmehdi0508@gmail.com
Received: May 21, 2025
Revised: June 13, 2025
Accepted: August 4, 2025
Published online: August 26, 2025
Processing time: 92 Days and 10 Hours
Abstract
BACKGROUND

Sex disparities in clinical outcomes following thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection (TBAD) are not well understood.

AIM

To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.

METHODS

A systematic search of PubMed, EMBASE, Cochrane Library, and ScienceDirect identified five studies involving 2572 patients (1153 males and 1419 females). The primary outcome was hospital mortality. Secondary outcomes included reintervention rates, acute kidney injury (AKI), ischemic stroke, limb ischemia, and spinal cord ischemia. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic.

RESULTS

The primary outcome showed no significant difference between males and females for hospital mortality (OR: 1.13, 95%CI: 0.81-1.59, P = 0.47, I2 = 0). Among secondary outcomes, males had a significantly higher risk of AKI (OR: 1.55, 95%CI: 1.21-2.00, P = 0.0006, I² = 0). No differences were observed for reintervention rates, ischemic stroke, limb ischemia, or spinal cord ischemia.

CONCLUSION

Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality, ischemic events, reintervention, and other complications. Future research should explore mechanisms and strategies to optimize outcomes.

Keywords: Thoracic endovascular aortic repair; Type B aortic dissection; Sex; Outcomes; Acute kidney injury

Core Tip: This meta-analysis demonstrates that while most clinical outcomes following thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection are comparable between sexes, male patients face a higher risk of postoperative acute kidney injury (AKI). By addressing modifiable risk factors and exploring innovative care models, clinicians can reduce the burden of AKI and enhance care for patients undergoing TEVAR.