Aortic Dissection in Northern Pakistan and Afghanistan and Its Surgical Outcome

Background: The aorta can be involved in different pathologies, including congenital, syndromic and acquired disorders, which may need intervention in some form to prevent catastrophe. The purpose of this study is to review the clinical presentation of type A aortic dissection (TAAD) and associated procedural outcomes in northern Pakistan and Afghanistan. Methods: A retrospective database review was conducted at a tertiary care hospital from January 2017 to December 2023. A total of 115 patients operated for different diseases of the aorta in a single centre over a period of 7 years were included. Institutional review board approval was granted. Data were analysed using SPSS 25; variables were recorded in frequency and mean. Results: The mean age was 44.9 ± 18.3 years. Most patients were male (83.4%), and the oldest patient was aged 76 years. Hypertension was the most common comorbidity (41.7%). New York Heart Association class III (36.5%) was the most common severity of presenting complaints. Most cases were elective (82%). Surgery without cardiopulmonary bypass was carried out in 52.1% while the remaining 47.8% cases required cardiopulmonary bypass. The overall inpatient mortality of off-pump cases was 5% compared to 18.2% in on-pump cases. This study includes 20 cases of TAAD involving the root or ascending aorta. The overall mortality rate for TAAD was seven (35%) out of 20 patients. All of them were men (mean age 43.8 ± 16.3 years). Conclusion: Aortic pathology frequently manifests in various anatomical locations in both elective and emergency scenarios. Although surgical interventions successfully address various aortic pathologies, these procedures still pose risks. The presence of dissection and emergency presentation are major risk factors.