Abstract Introduction Acute cerebral complications are common after open surgery for acute aortic dissection and postoperative cognitive dysfunction occurs both after acute and elective aortic operations. It is not known if the high early incidences of these complications translate into an increased long-term risk for dementia after aortic surgery on a population level. Purpose To assess the long-term risk of dementia after surgery for aortic dissection type A and elective surgery for ascending aortic aneurysm compared to matched control individuals from the general population. Methods All patients ≥18 years old, that underwent surgery for acute aortic dissection type A or ascending aortic aneurysm in Sweden 1997-2020 and survived until discharge were included in an observational population-based nationwide cohort study. Control subjects from the general population without a history of cardiac or thoracic aortic interventions were matched 4:1 based on age, sex and place of residence. Individual patient and control subject data was collected from the SWEDEHEART registry and four other mandatory national databases and registries. Multivariable Cox regression models adjusted for age, sex and comorbidities at baseline were used to compare the risk for dementia in the different study groups and to identify risk factors for dementia. Results A total of 2 784 patients operated for dissection (mean age 62±12 years, 34.2% women), 5 427 patients operated for aortic ascending aneurysm (mean age 62±13 years, 29.4% women) and 30 573 controls were included. Median follow-up was 5.8 years (range 0-24 years). Dementia was diagnosed during follow-up in 1 521/38 784 (3.9%) of all study subjects, see figure. The cumulative incidence of dementia after 10 years, adjusted for the competing risk of death, was 4.1% in patients operated for dissection 5.3% in patients operated for aneurysm and 4.6% in control subjects. Compared to the control subjects, neither patients operated for dissection (adjusted hazard ratio (aHR) 1.00 (95%CI 0.80-1.26), p=0.97) nor for aortic aneurysm (aHR 0.87 (95%CI 0.72-1.06), P=0.18) had an increased long-term risk for dementia. In a direct comparison, the risk did not differ significantly between patients operated for dissection or aneurysm (aHR 1.08 (95%CI 0.84-1.38), p=0.56). Independent risk factors for dementia were age (aHR 1.16 (95%CI 1.16-1.17) per year), diabetes (aHR 1.54 (95%CI 1.29-1.84)), previous stroke (aHR 1.80 (95%CI 1.49-1.2.18)) and peripheral vascular disease (aHR 1.30 (95%CI 1.07-1.57)), while hyperlipidaemia was associated with decreased risk of dementia (aHR 0.77 (95%CI 0.60-0.98). Conclusion In this nationwide cohort study with long follow up of patients operated for aortic dissection type A or ascending aortic aneurysm did not show an increased long-term risk of dementia compared to matched individuals from the general population.Cumulative incidence of dementia
Ostman et al. (Sat,) studied this question.