title: The Chronobiology of Stanford Type A Aortic Dissections: A Comparison of Northern versus Southern Hemispheres.
abstract: BACKGROUND
  Seasonal variations of Stanford Type A dissections (STADs) have been previously described in the Northern Hemisphere (NH). This study sought to determine if these variation are mirrored in the Southern Hemisphere (SH).
  
  
  METHODS
  Data from patients treated surgically for STADs were retrospectively obtained from existing administrative and clinical databases from NH and SH sites. Data points of interest included age, sex, date of dissection, and 30-day mortality. The dates of dissections (independent of year) were then organized by season.
  
  
  RESULTS
  A total of 1418 patients were identified (729 NH and 689 SH) with complete data available for 1415; 896 patients were male with a mean age was 61 ± 14 years, and the overall 30-day mortality was 17.3%. Comparison of NH and SH on a month-to-month basis demonstrated a 6-month phase shift and a significant difference by season, with STADs occurring predominantly in the winter and least in the summer. Decomposition of the monthly incidence using Fourier analysis revealed the phase shift of the primary harmonic to be -21.9 and 169.8 degrees (days), respectively, for NH and SH. The resultant 191.7 day difference did not exactly correspond to the anticipated 6-month difference but was compatible with the original hypothesis.
  
  
  CONCLUSIONS
  Chronobiology plays a role in the occurrence of STADs with the highest occurrence in the winter months independent of the hemisphere. Season is not the predominant reason why aortas dissect, but for patients at risk, the increase in systemic vascular resistance during the winter months may account for the seasonal variations seen.
authors.affiliation: Division of Cardiothoracic Surgery, University of Texas Medical Branch - Galveston, Galveston, TX, USA.
authors.forename: Abe
authors.initials: A
authors.lastname: DeAnda
authors.affiliation: Department of Cardiothoracic Surgery, New York University, New York, New York, USA.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
authors.affiliation: Department of Cardiothoracic Surgery, New York University, New York, New York, USA.
authors.forename: Leora B
authors.initials: LB
authors.lastname: Balsam
authors.affiliation: Division of Cardiothoracic Surgery, Washington University-St. Louis, St. Louis, Missouri, USA.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Moon
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Southampton, Southampton, UK.
authors.forename: Clifford W
authors.initials: CW
authors.lastname: Barlow
authors.affiliation: Department of Cardiothoracic Surgery, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Navia
authors.affiliation: Department of Cardiothoracic Surgery, New York University, New York, New York, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ursomanno
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Bulat A
authors.initials: BA
authors.lastname: Ziganshin
authors.affiliation: Department of Cardiothoracic Surgery, New York University, New York, New York, USA.
authors.forename: Annette E
authors.initials: AE
authors.lastname: Rabinovich
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Elefteriades
authors.affiliation: Department of Cardiothoracic Surgery, Monash Medical Centre, and Department of Surgery (MMC), Monash University, Clayton, Victoria, Australia.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
keywords: Aortic dissection; Chronobiology