Surgery for acute type A aortic dissection in octogenarians is justified

Tang, Gilbert H.L.; Malekan, Ramin; Yu, Cindy J.; Kai, Masashi; Lansman, Steven L.; Spielvogel, David

doi:10.1016/j.jtcvs.2012.11.060

Cited by 65 publications

(66 citation statements)

References 17 publications

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“…For short term mortality, the analysis was conducted on four studies (6,7,9,14): results were similar to the overall analysis with a RR of 2.30 (95% CI, 1.29-4.09; P=0.0047). (95% CI, 0.30-3.56, P=0.08) for the random effect model.…”

Section: Sub-analysis In Octogenariansmentioning

confidence: 54%

“…Only seven studies (1,6,7,(11)(12)(13)(14) reported post-operative stroke rates with an incidence in the elderly group ranging from 4.76% to 28.3 %, with a pooled rate of 19.2%. A total of 348 elderly patients over an overall population of 1,204 patients were included into this meta-analysis.…”

Section: Post-operative Strokementioning

confidence: 99%

“…Post-operative AKI was evaluated in six studies (1,6,(11)(12)(13)(14) and involved 296 elderly patients in an overall population of 997 patients (29.7%). The pooled incidence of postoperative AKI in elderly was 7.8%.…”

Section: Post-operative Acute Kidney Injurymentioning

confidence: 99%

“…In contrast, a meta-analysis published in 2011 (4) and focused on octogenarian patients showed satisfactory immediate survival rate after surgery and suggested a confident approach toward emergency repair in this complex subset of patients. Enhancements in diagnostics, surgical techniques and post-operative care have certainly improved over the last years and more recent registry reports and retrospective analysis have revealed very good results after AAD surgical repair in the aged population, supporting surgical intervention even in very elderly patients (5,6). We investigated the current evidence on the surgical outcome of AAD repair in elderly patients by conducting a contemporary systematic review and meta-analysis of the latest published studies on this topic.…”

Section: Introductionmentioning

confidence: 99%

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

Bruno¹,

Chivasso²,

Guida³

et al. 2016

Ann. Cardiothorac. Surg.

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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 metaanalysis. Pooled meta-analysis showed an increased risk of short term mortality for the elderly population 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.

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Section: Sub-analysis In Octogenariansmentioning

confidence: 54%

Section: Post-operative Strokementioning

confidence: 99%

Section: Post-operative Acute Kidney Injurymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Bruno¹,

Chivasso²,

Guida³

et al. 2016

Ann. Cardiothorac. Surg.

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show abstract

“…In octogenarians, in-hospital mortality was lower after surgery than with medical treatment (37.9% vs. 55.2%); but the difference failed to reach statistical significance due to the limited number of participants over the age of 80 years (19). Although some have reported excellent surgical results and quality of life outcomes in the elderly (20), others found a higher rate of post-operative neurological complications (21). Based on current evidence, age per se should not be considered an exclusion criterion for surgical treatment.…”

Section: Type a Admentioning

confidence: 97%