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

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.