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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 D’Auria, Alberto Siracusano, Giovanni Ruvolo, Luigi Chiariello.

Abstract
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

Key words: Acute aortic dissection, aortic surgery, psychiatric disorders



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