Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
Eur J Cardiothorac Surg. 2011 Nov;40(5):1058-63. doi: 10.1016/j.ejcts.2011.03.044. Epub 2011 May 10.
The benefits of surgical treatment of type A aortic dissection (AAD) in patients aged 80 years and older are questioned by the perceived high operative risk of these patients. This issue has been investigated in the present meta-analysis of observational studies.
Studies on surgical repair of AAD in patients aged 80 years and older were identified up to January 2011. The results were expressed as pooled proportions with 95% confidence interval (95% CI).
Pooled analysis showed that patients aged 80 years and older included in six studies had a significantly higher risk of immediate postoperative mortality compared with younger patients (risk ratio 2.32, 95% CI 1.47-3.66, p<0.0001, pooled estimates 45.7% vs 19.5%). Analysis of data retrieved from nine studies reporting on the results of surgical treatment of AAD in a total of 308 patients aged 80 years and older showed a pooled mortality rate of 36.7% (95% CI 23.8-51.8%, 111/308 patients). The pooled stroke rate was 11.9% (95% CI 7.3-18.7%, 37/347 patients). Pooled analysis of data from two studies evaluating patients surgically or medically treated showed a non-significant reduced risk of immediate postoperative death after surgery (risk ratio 0.42, 95% CI 0.14-1.29, pooled estimates: 25.2% vs 59.0%).
Immediate postoperative survival rates after surgery for AAD in patients aged 80 years and older are satisfactory. These findings suggest a confident approach toward emergency repair of AAD in this fragile patient population. More data on the intermediate survival and quality of life of these patients are, however, needed to better establish the role of emergency surgery for AAD in octogenarians and nonagenarians.
由于 80 岁及以上高龄患者的手术风险较高，人们对手术治疗 A 型主动脉夹层（AAD）的获益产生了质疑。本研究通过对观察性研究的荟萃分析对此问题进行了探讨。
截至 2011 年 1 月，检索关于 80 岁及以上高龄患者 AAD 手术治疗的研究。结果以合并后 95%可信区间（95%CI）表示。
共纳入 6 项研究，荟萃分析显示高龄患者术后即刻病死率显著高于年轻患者（风险比 2.32，95%CI 1.47-3.66，p<0.0001，合并后估计值 45.7% vs 19.5%）。9 项研究报道了共 308 例 80 岁及以上高龄患者的 AAD 手术治疗结果，其中 111 例（36.7%）死亡；荟萃分析显示，该组患者的死亡率为 36.7%（95%CI 23.8-51.8%，111/308 例）。347 例患者中，卒中发生率为 11.9%（95%CI 7.3-18.7%，37/347 例）。2 项研究评估了手术和内科治疗患者，荟萃分析显示手术治疗后即刻病死率降低，但差异无统计学意义（风险比 0.42，95%CI 0.14-1.29，合并后估计值：25.2% vs 59.0%）。
80 岁及以上高龄患者 AAD 手术后的即刻生存率令人满意。这些发现提示在这一脆弱患者群体中，可对 AAD 进行积极的急诊修复。但需要更多关于该组患者的中期生存和生活质量的数据，以更好地确定高龄患者 AAD 的急诊手术治疗地位。
