DOI: 10.1161/circ.148.suppl_1.13355 ISSN: 0009-7322

Abstract 13355: Acute Type A Aortic Dissection Surgical Repair in Octogenarians, Meta Analysis

Ahmed K. Awad, Mohammed Tarek Hasan, Hazem Salah Rezq, Heba Aboeldahab, Mohamed K. Elkhashab, Salah Mahmoud Hamouda, Hassan Elkersh, Ayman K. Awad, Ambreen Nabeel, Syed Karam Gardezi, Rehmat Ullah Awan
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Aortic dissection is a serious medical condition that can lead to life-threatening complications. Type A aortic dissection (TAAD) is a subtype that occurs in the ascending aorta and is associated with increased morbidity and mortality rates. Surgical intervention is the standard of care for TAAD, but the optimal surgical approach for octogenarians remains a topic of debate. This meta-analysis aimed to investigate the long-term surgical outcomes of TAAD in octogenarians.

Electronic databases were searched from inception to September 20, 2022, to include any randomized clinical trials (RCT) and observational studies that compare TAAD in octogenarians versus TAAD in septuagenarians. The Mantel-Haenszel method was used to pool study estimates and calculate odds ratios (OR) with 95% confidence intervals (CI).

Twenty-seven observational studies comprising 18,057 participants were included in the meta-analysis. Surgical repair for TAAD in octogenarians had a lower risk of re-exploration (RR = 0.08), stroke (RR = 0.09), renal failure (RR = 0.09), respiratory failure (RR = 0.18), neurological complications (RR = 0.09), and bleeding (RR = 0.08), compared to septuagenarians. On the other hand, antegrade cerebral perfusion (RR = 0.39) and tracheostomy (RR = 0.11) were less likely to be used in octogenarians than in septuagenarians. In terms of surgical parameters, octogenarians had a significantly shorter cardiopulmonary bypass surgery time and systemic cardiac arrest time than septuagenarians (MD = -13.84 and -2.46), respectively.

Even though postoperative mortality rose dramatically with age, surgical care was associated with a significantly reduced inpatient mortality rate when compared to medical management. Octogenarians undergoing surgical repair for type A aortic dissection have a statistically significant difference in cardiopulmonary bypass surgery time, systemic cardiac arrest time, and 5-year survival rate when compared to septuagenarians.

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