Abstract
Background:
Seasonal variations of Stanford Type A dissections (STADs) have been previously described
in the Northern Hemisphere (NH). This study sought to determine if these variation
are mirrored in the Southern Hemisphere (SH).
Methods:
Data from patients treated surgically for STADs were retrospectively obtained from
existing administrative and clinical databases from NH and SH sites. Data points of
interest included age, sex, date of dissection, and 30-day mortality. The dates of
dissections (independent of year) were then organized by season.
Results:
A total of 1418 patients were identified (729 NH and 689 SH) with complete data available
for 1415; 896 patients were male with a mean age was 61 ± 14 years, and the overall
30-day mortality was 17.3%. Comparison of NH and SH on a month-to-month basis demonstrated
a 6-month phase shift and a significant difference by season, with STADs occurring
predominantly in the winter and least in the summer. Decomposition of the monthly
incidence using Fourier analysis revealed the phase shift of the primary harmonic
to be –21.9 and 169.8 degrees (days), respectively, for NH and SH. The resultant 191.7
day difference did not exactly correspond to the anticipated 6-month difference but
was compatible with the original hypothesis.
Conclusion:
Chronobiology plays a role in the occurrence of STADs with the highest occurrence
in the winter months independent of the hemisphere. Season is not the predominant
reason why aortas dissect, but for patients at risk, the increase in systemic vascular
resistance during the winter months may account for the seasonal variations seen.
Key Words
Aortic dissection - Chronobiology
