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

Philipp Angleitner1, Derek R Brinster2, Thomas G Gleason3

  • 1Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.

Seminars in Thoracic and Cardiovascular Surgery
|June 19, 2021
PubMed

Insights

Elderly patients with type A acute aortic dissection and stroke face higher in-hospital mortality. However, stroke does not impact long-term survival in hospital survivors. Medical management shows poor outcomes.

Area of Science:

  • Cardiology
  • Neurology
  • Geriatric Medicine

Background:

  • Type A acute aortic dissection (TAAAD) in patients aged 70 years or above is a critical condition.
  • The presence of cerebrovascular accident (CVA) in this demographic complicates management and prognosis.
  • Understanding the impact of CVA on outcomes is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To analyze the in-hospital and long-term outcomes of elderly patients (≥70 years) with TAAAD and pre-existing CVA.
  • To compare outcomes between patients with and without CVA undergoing surgical management.
  • To describe the outcomes of medically managed TAAAD patients with CVA.

Main Methods:

  • Retrospective analysis of the International Registry of Acute Aortic Dissection (IRAD) database.
  • Stratification of patients aged ≥70 years based on the presence or absence of CVA before surgery.
  • Analysis of in-hospital mortality, post-operative CVA, and long-term mortality up to 5 years.

Main Results:

  • Patients with CVA had significantly higher in-hospital mortality (32.7% vs 21.7%) and post-operative CVA rates (23.4% vs 8.3%).
  • Pre-existing CVA was an independent predictor of increased in-hospital mortality (OR 2.99).
  • In hospital survivors, pre-existing CVA did not independently influence mortality up to 5 years (HR 1.52).
  • Medically managed patients with CVA exhibited extremely high in-hospital mortality (71.4%) and CVA rates (90.9%).

Conclusions:

  • Elderly patients (≥70 years) with TAAAD and CVA face a substantially increased risk of in-hospital mortality.
  • While CVA worsens immediate outcomes, it does not appear to affect long-term survival in hospital survivors.
  • Medical management is associated with poor outcomes, suggesting surgical intervention should be considered after careful comorbidity assessment.

Keywords:
Aortic dissectionCerebrovascular accidentInternational registry of acute aortic dissectionStrokeType A acute aortic dissection

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