Population-Based Study of the Incidence and Mortality Rate of Acute Aortic Dissection.

BACKGROUND: Acute aortic dissection (AAD) has high morbidity and a high fatality rate for a cardiovascular disease. Recent studies suggested that the incidence of AAD is increasing. However, the actual incidence and mortality rates of AAD are not well known. This study investigated the current epidemiology of AAD within the Yatsushiro medical jurisdictional area.Methods and Results: A population-based review of patients with AAD was performed in a geographically well-defined area. Data were collected retrospectively from January 2011 to December 2020 for a total of 196 patients with AAD (Stanford Type A, n=126 [64.3%]; Stanford Type B, n=70 [35.7%]). The mean patient age was 74.3 years, and 55.6% (109/196) were women. The crude and age-standardized incidence rates of AAD in our medical jurisdictional area were 13.6 and 11.4 per 100,000 inhabitants per year, respectively. The crude and age-standardized 30-day mortality rates of AAD were 4.9 and 4.0 per 100,000 inhabitants per year, respectively. There were upward tendencies for both the incidence and 30-day mortality rate of AAD with age, with both being significantly higher in patients aged ≥85 years (P<0.001). CONCLUSIONS: This population-based study detected a higher incidence of AAD than previous studies, but reported a lower incidence of AAD in men than in women. Increasing age was associated with an increased incidence and mortality rate of AAD.

[Cardiovascular Surgery in Nonagenarian].

OBJECTIVE: The number of nonagenarians who are eligible for surgery is increasing in Japan with the increase of the elderly population and the improvement of outcomes of cardiovascular surgery. METHODS: Six nonagenarians underwent cardiovascular surgery from January 2014 to December 2022. Frailty, activity of daily living, and postoperative survival were examined. RESULTS: The mean age was 90.8 (90-92) years old. Seven operations (2 coronary artery bypass, 3 cardiac valve surgery, and 2 ascending aorta replacement) were performed in 6 patients( 2 males and 4 females). Four of them were emergent or urgent surgery. The mean hospital stay was 39.0 days, without postoperative 30-day or in-hospital deaths. However, two patients died of aspiration pneumonia and cancer. Although early postoperative activities of daily living( ADL) was declined, ADL was improved to the same level as preoperative status, one year after operation. The mean postoperative observation period was 988.3 days, and the longest postoperative survival was 2,676 days. CONCLUSION: Nonagenarians may have acceptable outcomes with cardiovascular surgery by evaluating not only age but also ADL and frailty.

Factors Affecting Recovery of 6-Minute Walk Distance After Coronary Artery Bypass Grafting.

Background: This single-center retrospective analysis investigated the number of days required for postoperative 6-minute walk distance (6MWD) to recover to preoperative values after coronary artery bypass grafting (CABG) and the factors influencing this recovery. Methods and Results: The 6MWD was measured in 101 patients (median age 69 years; 18 women) before and every day after CABG. Univariate and multivariate analyses were performed to identify factors affecting 6MWD recovery to preoperative values after CABG. The median number of days required for recovery of 6MWD after CABG was 9 (interquartile range 7-11 days). Patients were divided into 2 groups based on the median number of days required for recovery of 6MWD; there were 60 patients in the early recovery group (<9 days) and 41 in the "non-early" recovery group (38 who recovered after the median 9 days, and 3 who did not recover during hospitalization). Using univariate logistic regression analysis, diabetes (P=0.01), stroke (P=0.26), left ventricular ejection fraction (P=0.27), and grip strength (P=0.13) were selected for multivariate analysis. Multivariate logistic regression analysis revealed that diabetes (odds ratio 2.955; 95% confidence interval 1.208-7.229; P=0.02) was the only independent predictor of 6MWD recovery. Conclusions: Diabetes was the single factor influencing the recovery of postoperative 6MWD in patients undergoing CABG.