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

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.

Keywords: Aortic dissection; elderly; meta-analysis; systematic review.

Figure 1

PRISMA diagram describing the search results. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Forest plot of the pooled risk ratio for short-term mortality (test for overall effect Z=7.032, P<0.001; Heterogeneity test: I²=0%, Chi²=7.1, df=10, P=0.6271).

Figure 3

Forest plot of the pooled risk ratio for post-operative stroke rate (Test for overall effect Z=1.0648, P=0.287; Heterogeneity tests: I²=0%, Chi²=2.56, df=5, P=0.86).

Figure 4

Forest plot for the pooled risk ratio for developing acute kidney injury (AKI) after surgery (Test for overall effect: Fixed effect model: Z=−1.014, P=0.31, Random effect model: Z=−0.8053; P=0.42; Heterogeneity tests: I²=14%, Q=5.82, df=5, P=0.32).