Persistency of the false lumen increases late mortality in acute aortic dissection: A systematic review and meta-analysis

Objectives: Acute aortic dissection (AAD) is a critical vascular emergency with distinct outcomes for type A and type B patients. Despite recent improvements in surgical outcomes and lower mortality, the long-term impact of the false lumen status on future patients’ outcomes remains uncertain. This systematic review and meta-analysis aimed to comprehensively evaluate the long-term prognostic implications of false lumen status in patients presenting with AAD. Methods: A meticulous literature search was conducted in PubMed, Embase, Scopus, Web of Science, and Cochrane Central, covering the period from 1995 to April 2023, in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria encompassed studies on AAD reporting the prognostic impact of false lumen status, with a follow-up duration exceeding 1 year. Two independent researchers conducted data extraction and quality assessment. Study quality was assessed using the Newcastle–Ottawa scale. Meta-analysis was performed using the Comprehensive Meta-Analysis (CMA) software. Random effects model of data synthesis was chosen with effect size measure selected as hazard ratio (HR), and heterogeneity was assessed with the Higgins I 2 statistic. Results: The review encompassed 20 studies involving 4247 patients with AAD. Patent false lumen was significantly associated with increased long-term mortality (HR = 1.73; 95% confidence interval [CI], 1.25–2.39; P = 0.001; I 2 = 2.6%) and aortic events (HR = 2.80; 95% CI, 1.71–4.75; P < 0.001; I 2 = 55.6%), with stronger associations observed in Asian populations compared with non-Asian cohorts. The analysis revealed a significant correlation between patent false lumen and heightened risks of both long-term mortality and aortic events in both types A and B AAD patients. Partially thrombosed false lumens showed an association with increased long-term mortality, particularly in type A aortic dissection cases, while completely thrombosed false lumens did not exhibit significant associations with adverse outcomes. Subgroup analyses showed a higher risk of long-term mortality in type A compared with type B, particularly among Asian populations with smaller sample sizes and shorter follow-up durations. Conclusion: The present systematic review provides critical insights into the relationship between false lumen status and long-term outcomes in AAD. This will help in risk assessment and tailoring treatment for these patients. Strict long-term follow-up is warranted in patients with patent false lumen, and selective late intervention may be considered in high-risk individuals based on clinical judgment.