Acute type A aortic dissection (TAAD) is the most frequently encountered pathological condition of the aorta and constitutes one of the most fatal cardiovascular emergencies. This study aimed to determine the risk factors in aortic dissection and aortic dissection-related mortality by examining the characteristics of surgically treated TAAD cases and autopsied TAAD cases. A total of 157 cases from two centers were included in the study between 2003 and 2022: 141 cases of acute TAAD who underwent surgical treatment at the Department of Cardiovascular Surgery, and 16 autopsied cases identified at the Forensic Medicine Morgue Department. Medical records of the surgically treated patients at the Department of Cardiovascular Surgery and autopsy reports from the Forensic Medicine Morgue Department were reviewed, and the findings from both centers were evaluated. Of all cases included in the study, 72.6% were male and 46.9% were between 46 and 64 years of age. The mortality rate among surgically treated cases was 17%. The mortality rate was 30.6% in surgically treated cases with preoperative malperfusion and 9.8% in those without malperfusion. Hypertension was the most prevalent comorbidity, being present in 93.6% of the cases. Multivariable logistic regression analysis showed that the presence of preoperative malperfusion increased the risk of mortality by approximately 2.9-fold, while age was not identified as an independent risk factor in the model. Malperfusion was identified as the factor most strongly associated with mortality in surgically treated cases, and its independent association with an approximately 2.9-fold increase in mortality supports its role as one of the major determinants of prognosis. The high prevalence of atheromatous plaques in the aorta and coronary arteries in autopsied cases suggests a possible relationship between atherosclerosis and mortality in TAAD cases.
Yılmaz et al. (Thu,) studied this question.