Ascending aortic atherosclerosis in ATAAD patients was associated with higher postoperative stroke (41.4% vs 21.7%, p=0.034) but lower aortic reintervention (5.2% vs 19.6%, p=0.023).
Cohort (n=104)
No
Does the presence of ascending aortic atherosclerosis affect postoperative outcomes in patients undergoing surgery for acute Type A aortic dissection?
In patients undergoing surgery for acute Type A aortic dissection, ascending aortic atherosclerosis is associated with a higher incidence of postoperative stroke but a lower rate of aortic reintervention, without affecting overall survival.
Absolute Event Rate: 41.4% vs 21.7%
p-value: p=0.034
Objectives Ascending aortic atherosclerosis and degeneration may influence surgical management and outcome following surgery for acute Type A aortic dissection (ATAAD). The aim of this study was to evaluate the association between histologically confirmed ascending aortic atherosclerosis and postoperative outcome in patients undergoing surgery for ATAAD. Methods We retrospectively evaluated 104 patients without connective tissue disorders undergoing surgery for ATAAD at Tampere University Hospital between January 2005 and November 2019. Resected ascending aortic specimens were processed for histopathology, assessing atherosclerosis, medial degeneration, and inflammation. Patients were divided into groups based on the presence ( n = 58) or absence ( n = 46) of histologically confirmed atherosclerosis and compared over a median follow‐up of 5.9 years (interquartile range IQR: 0.9–8.0). Results The median age for all patients was 67.0 years (IQR: 57.0–73.0). Patients with atherosclerosis had more frequent primary intimal tears in the aortic root (62.1% vs. 39.1%, p = 0.020), but less frequent limb malperfusion (5.2% vs. 32.6%, p < 0.001), and DeBakey I dissections (53.4% vs. 76.1%, p = 0.017) as compared to those without atherosclerosis, respectively. The presence and severity of medial degeneration were significantly greater in patients with atherosclerosis (98.3% vs. 87.0%, p = 0.042; mean severity score 2.2 vs. 1.8, p = 0.044). Postoperatively, the incidence of stroke was significantly higher in the atherosclerosis group (41.4% vs. 21.7%, p = 0.034), but the rate of aortic reintervention was significantly lower (5.2% vs. 19.6%, p = 0.023). Survival did not differ significantly between the groups (log‐rank p = 0.683), and limb malperfusion was the only strong independent risk factor for all‐cause mortality according to multivariable Cox regression analysis. Conclusion Ascending aortic atherosclerosis including severe medial degeneration during ATAAD is associated with distinct clinical features such as the presence of proximal aortic root tear. Instead, limb malperfusion, DeBakey I classification, and presence of ascending aortic tear suggest an ascending aorta without atherosclerosis, often associated with increased risk of aortic reinterventions after surgery for ATAAD.
Heikurinen et al. (Thu,) conducted a cohort in Acute Type A aortic dissection (ATAAD) (n=104). Presence of ascending aortic atherosclerosis vs. Absence of ascending aortic atherosclerosis was evaluated on Postoperative stroke (p=0.034). Ascending aortic atherosclerosis in ATAAD patients was associated with higher postoperative stroke (41.4% vs 21.7%, p=0.034) but lower aortic reintervention (5.2% vs 19.6%, p=0.023).