Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

Vito D Bruno, Pierpaolo Chivasso, Gustavo Guida, Hunaid A Vohra

Research output: Contribution to journalArticle (Academic Journal)peer-review

10 Citations (Scopus)
273 Downloads (Pure)

Abstract

BACKGROUND: The results of surgical treatment of type A aortic dissection (AAD) in the elderly are controversial and aggravated by a higher operative mortality rate. The studies published in this subset of patients are mainly retrospective analyses or small samples from international registries. We sought to investigate this topic by conducting a contemporary meta-analysis of the most recent observational studies.

METHODS: A systematic literature search was conducted for any study published in the last five years on aortic dissection treated surgically in patients 70 years and older. A pooled risk-ratio meta-analysis has been conducted three main post-operative outcomes: short-term mortality, stroke and acute kidney injury.

RESULTS: A total of 11 retrospective observational studies have been included in the quantitative meta-analysis. Pooled meta-analysis showed an increased risk of short term mortality for the elderly population [relative risk (RR) =2.25; 95% CI, 1.79-2.83; I (2)=0%; P<0.0001], and this has been confirmed in a sub-analysis of patients 80 years and older. The risk of having stroke (RR =1.15; 95% CI, 0.89-1.5; I (2)=0%; P=0.28) and acute kidney injury (RR =0.79; 95% CI, 0.5-1.25, I (2)=14%, P=0.31) after surgery were comparable to the younger cohort of patients.

CONCLUSIONS: Although affected by an increased risk of short-term mortality in the elderly, surgical repair remains the treatment of choice for AAD. The main post-operative outcomes are comparable to younger patients and the mid-term survival rates are acceptable.

Original languageEnglish
Pages (from-to)257-64
Number of pages8
JournalAnnals of Cardiothoracic Surgery
Volume5
Issue number4
DOIs
Publication statusPublished - 3 Jun 2016

Keywords

  • Journal Article
  • Review
  • Aortic dissection
  • meta-analysis
  • systematic review
  • elderly

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