title: Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis.
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; I (2)=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; I (2)=0%; P=0.28) and acute kidney injury (RR =0.79; 95% CI, 0.5-1.25, I (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.
authors: Cardiac Surgery Department, Bristol Heart Institute, Bristol, UK.
authors: Vito D
authors: VD
authors: Bruno
authors: Cardiac Surgery Department, Bristol Heart Institute, Bristol, UK.
authors: Pierpaolo
authors: P
authors: Chivasso
authors: Cardiac Surgery Department, Bristol Heart Institute, Bristol, UK.
authors: Gustavo
authors: G
authors: Guida
authors: Cardiac Surgery Department, Bristol Heart Institute, Bristol, UK.
authors: Hunaid A
authors: HA
authors: Vohra
keywords: Aortic dissection; elderly; meta-analysis; systematic review