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Physical activities and surgical outcomes in elderly patients with acute type A aortic dissection

To the Editor, We read the article “Physical activities and surgical outcomes in elderly patients with acute type A aortic dissection” byTashima et al. with full assiduity. We appreciate the authors' efforts that they have put in this study to tell us about the strong correlation between physical activities and its association in elderly patients with acute type A aortic dissection. The authors have provided us with a great deal of knowledge and helped us to expand our awareness regarding this topic. However, we found some doubts when reading this article which we would like to highlight, as they might have affected the results of the study. First, even though the authors have mentioned significant comorbidities, sex, gender, and other physiologic and pathological associations, they have not mentioned whether there was an ongoing inflammatory condition and have not tested for acute phase reactants or other inflammatory markers, as it is well studied that ongoing inflammation in the aortic wall is directly linked to worse outcomes in patients with aortic dissection. Second, the authors also missed an important point in the patient's history; medical and surgical background. For representation, a 2010 study has shown that patients who have undergone previous cardiac surgery have an increased risk of postoperative morbidity and mortality compared to patients who have not undergone previous surgery. Third, even though the authors have excluded comorbidities and other significant laboratory findings such as hyperlipidemia, they have not correlated the values of “D dimers” with aortic dissection in their study. Elevated D dimers are considered an independent risk factor for poor prognosis in postoperative aortic dissection patients. We believe that if the authors had excluded D dimer values in patients with poor postoperative outcomes, this would have increased the yield of the study. Fourth, according to the original study, they have written that some patients while undergoing the procedure, developed the need for aortic valve replacement because of the location of the dissection, so authors should also have mentioned what were the outcomes in those patients or if those patients had any previous valvular abnormalities, such as according to a study Aortic Regurgitation is present in around 40% of patients with aortic dissection. There were also some other factors that, in our opinion, compromised the study, such as no relations were explained that whether the study group included any smokers as smoking is related to osteoporotic changes. It would have caused hindrance in physical activity for the older population being the primary cause of decreased physical activities after surgery. However, we found some dubieties while reading this article which we would like to highlight, as they might have affected the study outcomes.