Effects of psychiatric disorders on Type A acute aortic dissection pathogenesis and analysis of follow-up results


Paolo Nardi, Antonio Pellegrino, Francesco Bianchi, Marco Russo, Guglielmo Saitto, Piero Caporali, Francesca Dâ??Auria, Alberto Siracusano, Giovanni Ruvolo, Luigi Chiariello

Aims: A connection between psychiatric disorders (PDs) and Type A acute aortic dissection (AAD) has not been shown. The aim of this study was to define the psychological profile of patients treated for AAD, and to analyze the prevalence of PDs in their medical histories, in the immediate postoperative period, and at a mid-term follow-up. Patients and Methods: From March 2005 to October 2014, 240 consecutive patients underwent surgery for AAD. 60 patients (mean age 60 ± 13 years; 43 males) underwent psychiatric consultation postoperatively, and they represent the subjects of our retrospective study. Ascending aorta ± arch replacement was performed in 43 patients, whereas the Bentall procedure ± arch replacement was performed in 17. Data were retrospectively analyzed. Follow-ups were completed in 59 patients (mean duration 35 ± 23 months). Results: PDs were present in the medical histories of 34 patients. Postoperatively, in 28 cases, a definitive diagnosis of PD (group PD) was made in agreement with the diagnostic and statistical manual of mental disorders-IV criteria, including: Major depression (n = 13), anxious-depressive syndrome (n = 6), bipolar disorder Type 2 (n = 4), panic attacks (n = 2), paranoid schizophrenia (n = 1), and anxiety (n = 2). 32 patients without a definitive psychiatric diagnosis were classified as Group non-PD. In the postoperative period, clinical manifestations of PDs, including delirium, persistent spatio-temporal disorientation, and psychomotor agitation were evident in 22 patients (78%) in group PD versus 8 patients (25%) in group non-PD (P < 0.0001). During follow-up, only one death for non-cardiac reasons occurred in group PD. There were no suicides; only 10 patients of group PD required PD treatment (P < 0.0001 vs. early postoperative findings); 4 patients in group non-PD required PD treatment. Conclusion: Our findings suggest a strong relationship between PD and AAD. Because the psychiatric conditions appeared to be largely stable after surgery, treatment of AAD for patients affected by PDs seemed to represent the first step to detect their PDs and to start an appropriate medical therapy.