Abstract
Patients and Methods. 140 patients with aortic dissection type A were admitted for cardiac surgery. Seventy-seven patients experienced their dissection in the winter season (from November to April). We analyzed cases of ascending aortic dissection associated with alpine skiing. Results. In 17 patients we found skiing-related aortic dissections. Skiers were taller (180 (172–200) cm versus 175 (157–191) cm, P = 0.008) and heavier (90 (68–125) kg versus 80 (45–110) kg, P = 0.002) than nonskiers. An extension of aortic dissection into the aortic arch, the descending thoracic aorta, and the abdominal aorta was found in 91%, 74%, and 69%, respectively, with no significant difference between skiers and nonskiers. Skiers experienced RCA ostium dissection requiring CABG in 17.6% while this was true for 5% of nonskiers (P = 0.086). Hospital mortality of skiers was 6% versus 13% in nonskiers (P = 0.399). The skiers live at an altitude of 170 (0–853) m.a.s.l. and experience their dissection at 1602 (1185–3105; P < 0.001) m.a.s.l. In 82% symptom start was during recreational skiing without any trauma. Conclusion. Skiing associated aortic dissection type A is usually nontraumatic. The persons affected live at low altitudes and practice an outdoor sport at unusual high altitude at cold temperatures. Postoperative outcome is good.
Highlights
Alpine skiing is a popular sports activity
During the study period 140 patients with type A aortic dissection were admitted to our clinic of cardiac surgery. 77/140 (55%) patients were admitted during the winter seasons from the beginning of November until the end of April
During the winter season 17/77 (22.1%) of type A aortic dissections were associated with alpine skiing
Summary
Alpine skiing is a popular sports activity. For guests who are not acclimatized to high altitudes adaptation to the alpine climate means physical stress due to the combination of hypoxia plus unusual outdoor activity at low ambient temperatures. Skiing is known to be a complex sport with a relatively high demand of conditioning due to the typical pattern of short periods of moderate to heavy strenuous exercise and longer phases of interruption [1]. Due to these complex demands including cardiorespiratory, neuromuscular, and sensorimotor systems alpine skiing can be a challenge especially for the elder skier [2]. Hiratzka et al mention in the guidelines for the diagnosis and management of patients with thoracic aortic disease that thoracic stress or trauma may result from a skiing accident but in a typical traumatic injury of the descending aorta [3]. We aimed to analyze in detail all cases of skiing-associated ascending aortic dissection Stanford type A which were admitted to the clinic of cardiac surgery over a 10-year period
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