Acute Type A aortic dissection surgical repair in Octogenarians: A meta-analysis

Aortic dissection (AD), a life-threatening condition resulting from aortic wall tears, is especially concerning in the elderly. However, few studies have investigated long-term surgical outcomes in octogenarians with Type A aortic dissection (TAAD). Our paper addresses this critical knowledge gap. Four electronic databases were searched from inception till November 2022 to include any observational or randomized controlled trials (RCT) that evaluate long-term surgical outcomes of TAAD in octogenarians alone or compared with Septuagint focusing on factors including surgical approach, comorbidities, and preoperative status. The Mantel-Haenszel method was used to pool study estimates and calculate odds ratios (OR) with 95% confidence intervals (CI). We included 18,057 participants (10,253 males, 7804 females). In octogenarians and compared to medical treatment, surgical repair achieved significantly lower rates of re-exploration (9%), antegrade cerebral perfusion (33%), stroke (10%), and respiratory failure (19%). In terms of operative data, octogenarians had shorter cardiopulmonary bypass time (161.89 min), cross-clamp time (103.18 min), and myocardial ischemic time (90.89 min). Compared to septuagenarians, octogenarians had significantly shorter cardiopulmonary bypass and systemic cardiac arrest times (-13.84 min and -2.46 min, respectively). Additionally, octogenarians had a higher risk of respiratory complications (RR = 1.60). No significant differences were found for tracheostomy, antegrade cerebral perfusion, neurologic complications, and renal failure. In conclusion, octogenarians undergoing surgical repair for TAAD face relatively lower complication rates, but a higher risk of respiratory issues compared to septuagenarians, emphasizing the unique surgical challenges in this elderly fragile population.