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Background and aims of the study: Although relationships between ischemic heart disease and psychiatric disorders (PD) have been highlighted, a link between PD and acute aortic dissection (AAD) has not been shown. Aim of this study was to define the psychological profile of patients treated for AAD and analyze the impact of PD postoperatively and at 5-year follow-up period. Methods: Two-hundred and twelve patients underwent surgery for AAD during a 9-year period, and operative mortality was 26% (n = 55/212). Of 157 survived patients, 53 (34%) (mean age 59 ± 13 years; 40 males- 75.5%), underwent psychiatric consultation postoperatively. Ascending aorta +/- arch replacement was performed in 37 patients, Bentall +/- arch replacement in 16. Data were retrospectively analyzed. Mean duration of follow-up was 32 ± 25 months. Results: In 31 patients psychiatric changes were present in their medical history. Postoperatively in 25 of them a definitive diagnosis of PD (Group PD) was made in agreement of DSM-IV criteria as: major depression (n = 10), anxious-depressive syndrome (n = 5), bipolar disorder type 2 (n = 5), panic attacks (n = 2), paranoid schizophrenia (n = 1), anxiety (n = 2). Patients without a definitive psychiatric diagnosis were classified as Group non-PD (n = 28). In the postoperative period clinical manifestations of PD including delirium, persistent spatiotemporal disorientation, psychomotor agitation were evident in 20 patients (80%) in Group PD vs. 4 patients (14.8%) in Group non-PD (P < .0001). During follow-up neither deaths nor suicide attempts occurred; only 6 patients of Group PD required PD treatment (P < .0001 vs. early postoperative findings); 2 patients in Group non-PD required psychiatric medical treatment. Conclusion: Our findings suggest that the incidence of postoperative psychiatric complications is higher in patients affected by preoperative PD. During follow-up freedom from PD is lower in patients who experienced postoperative PD-related complications. Since the psychiatric conditions appeared to be comfortably stable during follow-up, treatment of AAD for patients affected by PD seemed to represent the first step to detect their psychiatric disorder and to start correct medical therapy.

international journal of clinical cardiology

The Effects of Coexistent Psychiatric Disorders in Patients Operated on for Acute Aortic Dissection on Postoperative Mental Health Status and on Mid-Term Time Period