Key result
Diabetes is linked to more severe aortic atherosclerosis during ATAAD, correlating with surgical extent.
Why the study?
Does diabetes mellitus affect the degree of aortic wall atherosclerosis and surgical solutions in patients undergoing surgery for acute type A aortic dissection?
Cohort (n=123)
No
Does diabetes mellitus affect the degree of aortic wall atherosclerosis and surgical solutions in patients undergoing surgery for acute type A aortic dissection?
Absolute Event Rate: 0.8% vs 0.3%
p-value: p=0.009
Patients with diabetes mellitus have more severe aortic wall atherosclerosis during acute type A aortic dissection, which is associated with the extent of the surgical procedure.
Should not yet alter surgical extent or follow-up in diabetic ATAAD; leaves open need for prospective validation.
Background: Non-adjustable patient characteristics such as diabetes mellitus may influence surgical decision-making and outcome after acute type A aortic dissection (ATAAD). The aim of this study was to compare the degree of aortic wall atherosclerosis and surgical solutions in patients with diabetes mellitus versus those without during ATAAD. Methods: Altogether, 123 consecutive patients undergoing surgery for ATAAD at Tampere University Heart Hospital were evaluated. The ascending aortic wall resected in surgery was processed for histopathological analysis of atherosclerosis, inflammation, and medial layer degeneration. Patients with and without diabetes mellitus were compared during a mean 4.7-year follow-up. Results: There were 11 patients with diabetes mellitus and 112 without. The mean age for all patients was 63.6 years (standard deviation [SD] 13.3). Altogether, 48 patients had a conduit aortic prosthesis replacing the aortic root together with the ascending aorta, including only one patient with diabetes (p = 0.049). Nine patients received a frozen elephant trunk prosthesis to treat the aortic arch together with the ascending aorta. The severity of ascending aorta atherosclerosis was more prominent in patients with diabetes mellitus as compared to patients without (0.8 [0.4] vs. 0.3 [0.5], p = 0.009, respectively). During follow-up, 8 and 78 patients with and without diabetes died, respectively (logarithmic rank p = 0.187). Conclusions: Histopathology of the ascending aorta during ATAAD reveals distinctive severity of aortic wall atherosclerosis in patients with diabetes mellitus versus those without. The degree of atherosclerosis assessed postoperatively is associated with the extent of surgical procedure in many patients and may guide follow-up protocol.
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Heikurinen et al. (2025) conducted a cohort in Acute type A aortic dissection (ATAAD) (n=123). Diabetes mellitus vs. No diabetes mellitus was evaluated on Severity of ascending aorta atherosclerosis (p=0.009). Patients with diabetes mellitus undergoing surgery for acute type A aortic dissection had significantly more severe ascending aorta atherosclerosis than those without diabetes (0.8 vs 0.3, p=0.009).