Systematic Review and Meta-analysis of the Outcomes After Repair of Thoracoabdominal Aneurysms with the t-Branch Off-the-shelf Multibranched Stentgraft

Introduction: Endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs) has become the standard of treatment for most thoracoabdominal aortic pathologies, mostly due to the reduced perioperative mortality and morbidity. However, custom-made stentgrafts require detailed pre-operative planning and production time that can take up to 12 weeks. This may delay surgery in elective patients and is not an option for urgent or emergent cases. To surpass this limitation, the t-Branch (Cook Medical, Bloomington, IN) was launched in 2012 in Europe as an off-the-shelf standardized multibranched endograft for the endovascular treatment of thoracoabdominal aneurysms. Our aim was to collect and report the total published experience with the first commercially available off-the-shelf thoracoabdominal stentgraft. Methods: We performed a systematic inquiry of the MEDLINE database through Pubmed to identify studies that reported on the outcomes of patients treated with the t-Branch stentgraft and then conducted a qualitative synthesis and meta-analysis of the results. The main endpoints were mortality, major stroke, spinal cord ischemia (SCI) and renal insufficiency during the first 30 days. We estimated pooled proportions and 95% confidence intervals (CIs). Results: We identified 7 retrospective studies published between 2012 and 2018, with a total of 197 patients (mean age 72.3±7 years; 70% males). Among 165 patients, 45% were symptomatic and 19% were treated for a ruptured aortic aneurysm. In 197 patients, pooled technical success was 92.75% (95% CI: 83.9%-98.7%) and in 10% of the cases an early endoleak was detected (95% CI: 0-43.7%). Early mortality was 5.8% (95% CI: 2.5% to 10%) and major stroke was observed in 4% of the patients (95% CI: 0.96%-8.40%). The rate of spinal cord ischemia was 12.2% (95% CI: 4.1%-23.2%) with the rate of permanent paraplegia at 1.3% (95% CI: 0-8.7%). Acute renal failure was 18.7% (95% CI 9.1%-30.4%), while primary branch patency was calculated at 98.2% (95% CI: 96.7%-99.2%). Mean follow-up was 15±7 months. During this time midterm mortality (after 30 days) was 6.9% (95% CI: 2.44%-12.8%) and pooled re-intervention rate was 5.74% (95% CI: 1.70%-11.4%). Conclusion: This pooled analysis indicates good technical success rates of the t-Branch endograft implantation, with acceptable mortality and neurologic complications, despite a high rate of urgent procedures. Thoracoabdominal endovascular repair with the t-Branch endograft is a feasible and safe therapeutic option for patients with suitable anatomy. Disclosure: Nothing to disclose