Contemporary results after surgical repair of type A aortic dissection in patients aged 80 years and older: a systematic review and meta-analysis.

OBJECTIVE

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.

METHODS

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).

RESULTS

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%).

CONCLUSIONS

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.