Incidence of post-dissection aneurysmal formation and need for secondary intervention after surgery for acute type A aortic dissections: a systematic review and meta-analysis of observational studies

BACKGROUND: To perform a systematic review and meta-analysis of studies reporting the incidence of post-dissection aneurysms and need for secondary interventions after surgery for acute type A aortic dissections (ATAAD). METHODS: Following PRISMA guidelines, MEDLINE and CENTRAL databases were searched from inception to June 2023 for longitudinal studies reporting post-dissection aneurysmal formation and secondary interventions after surgery for ATAAD. The main outcome was the incidence of post-dissection aneurysms. Secondary outcomes included the incidence of post-dissection suture-line complications and secondary interventions related to aneurysmal complications. Additionally, the overall and aortic-related mortality during follow-up were pooled. RESULTS: One hundred and twenty-eight studies were included. The pooled calculated incidence of post-dissection aneurysmal formation after surgery for ATAAD was 10.24% (95% CI: 8.03-12.66). On sensitivity analysis considering only studies assessed having low risk of bias, incidence of post-dissection aneurysms increased to 24.9% (95% CI: 17.9-33.3). The incidence of suture line complications was 1.59% (95% CI: 0.98-22.30) and the incidence of late secondary interventions related to aortic aneurysmal complications was 12.00% (95% CI 10.12-14.00). Lastly, the calculated overall mortality was 17.53% (95% CI 14.71-20.53) and the aortic-related mortality was 1.59% (95% CI 1.08-2.18). CONCLUSIONS: The incidence of post-dissection aneurysmal formation in patients after previous surgery for acute type A aortic dissection in primarily untreated segments remains frequent. The reporting of this long-term issue has been broadly adopted in the aortic literature. Further studies are needed to assess the initial surgical strategy and its extent as well as a stringent follow-up protocol on early detection and intervention in these patients.