Surgical strategies in elderly patients with acute type A aortic dissection-a systematic review.

Systematic reviewFrontiers in surgery· 2026

Surgical strategies in elderly patients with acute type A aortic dissection-a systematic review.

Vanessa I T Zwaans, Lina Hülsenberg, Leonhard Wert … Leonard Pitts

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SurgerySystematic reviewTreatmentQ2IF 1.8

Thirty-day mortality averaged 21% after aortic dissection repair in patients over 70

Surgical strategies in elderly patients with acute type A aortic dissection-a systematic review.

Vanessa I T Zwaans … Leonard Pitts

Frontiers in surgery · 2026 · Q2 in Surgery

Background

Acute type A aortic dissection (ATAAD) is a life-threatening emergency requiring urgent surgery.

Purpose

This systematic review evaluates perioperative characteristics, surgical strategies in regard to outcomes and mortality in patients older than 70 years undergoing ATAAD repair.

Methods

Of 1,910 screened studies, 41 publications including 3,969 elderly patients were analyzed, encompassing randomized, observational and case-control designs.

n = 3,969 elderly patients

21%

Results

21%

roughly one in five elderly patients died within a month of surgery

n = 3,969 elderly patients

More results

A PRISMA-guided database search identified original studies published between 2000 and 2025.

Preoperative malperfusion occurred in 22.8% of patients, most commonly cerebral (16.7%) and renal (13.5%).

Mean cardiopulmonary bypass, cross-clamp and circulatory arrest times were 201, 104 and 45 min, respectively, at 23 °C.

More results

Long-term quality of life, assessed by SF-36, remained satisfactory.

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Conclusion

The available data suggests that advanced age was not consistently associated with withholding surgical treatment, especially in cases of absence of malperfusion.

Surgical strategies in elderly patients with acute type A aortic dissection-a systematic review.

Surgical strategies in elderly patients with acute type A aortic dissection-a systematic review.

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