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

Abstract

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 from the inception till August 2019 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 23 retrospective observational studies have been included in the metaanalysis. Pooled meta-analysis showed an increased risk of short-term mortality for the elderly population [relative risk (RR) =1.39; 95% CI, 0.64–3.5; I2=92%; P < 0.001], and this has been confirmed in a sub-analysis of patients 80 years and older. The risk of having stroke (RR = 1.47; 95% CI, 0.66–3.29; I2=91%; P = 0.35) and acute kidney injury (RR = 1.12; 95% CI, 0.32–3.9, I2=90%, P = 0.85) after surgery were comparable to the conservative treatment of patients. Conclusion 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.