Type A Acute Aortic Dissection Presenting With Cerebrovascular Accident at Advanced Age

• Published in: Seminars in thoracic and cardiovascular surgery 2022-01, Vol.34 (3), p.805-813
• Main Authors: Angleitner, Philipp, Brinster, Derek R., Gleason, Thomas G., Harris, Kevin M., Evangelista, Arturo, Bekeredjian, Raffi, Montgomery, Daniel G., Sandhu, Harleen K., Arnaoutakis, George J., Di Eusanio, Marco, Trimarchi, Santi, Nienaber, Christoph A., Isselbacher, Eric M., Eagle, Kim A., Ehrlich, Marek P.
• Format: Article
• Language: English
• Subjects: Aortic dissection; Cerebrovascular accident; International registry of acute aortic dissection; Stroke; Type A acute aortic dissection
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2021.06.008

Our aim was to analyze outcomes of patients aged 70 years or above presenting with type A acute aortic dissection (TAAAD) and cerebrovascular accident (CVA). A retrospective analysis of the International Registry of Acute Aortic Dissection (IRAD) was conducted. Patients aged 70 years or above (n = 1449) were stratified according to presence or absence of CVA before surgery (CVA: n = 110, 7.6%). In-hospital outcomes and mortality up to 5 years were analyzed. Additionally, in-hospital outcomes of patients who received medical management were described. No patient presenting with CVA over the age of 87 years underwent surgery. The rates of in-hospital mortality and post-operative CVA were significantly higher in patients presenting with CVA (in-hospital mortality: 32.7% vs 21.7%, P = 0.008; post-operative CVA: 23.4% vs 8.3%, P < 0.001). Presence of CVA was independently associated with significantly increased in-hospital mortality (odds ratio 2.99, 95% confidence interval 1.35 – 6.60, P = 0.007). In survivors of the hospital stay, presenting CVA had no independent influence on mortality up to 5 years (hazard ratio 1.52, 95% confidence interval 0.99 – 2.31, P = 0.54). In medically managed patients, exceedingly high rates of in-hospital mortality (71.4%) and CVA (90.9%) were noted. Patients presenting with TAAAD and CVA at ≥ 70 years of age are at significantly increased risk of in-hospital mortality, although long-term mortality is not affected in hospital survivors. Medical management is associated with poor outcomes. We believe that surgical management should be offered after critical assessment of comorbidities. [Display omitted]