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

  
@article{ACS11142,
	author = {Vito D. Bruno and Pierpaolo Chivasso and Gustavo Guida and Hunaid A. Vohra},
	title = {Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis},
	journal = {Annals of Cardiothoracic Surgery},
	volume = {5},
	number = {4},
	year = {2016},
	keywords = {},
	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; I2=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; I2=0%; P=0.28) and acute kidney injury (RR =0.79; 95% CI, 0.5–1.25, I2=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.},
	issn = {2225-319X},	url = {http://www.annalscts.com/article/view/11142}
}