University of Oulu

Henrik Bjursten, Daniel Oudin Åström, Shahab Nozohoor, Khalil Ahmad, Mariann Tang, Markus Bjurbom, Emma C Hansson, Anders Jeppsson, Christian Joost Holdflod Møller, Miko Jormalainen, Tatu Juvonen, Ari Mennander, Peter S Olsen, Christian Olsson, Anders Ahlsson, Anna Oudin, Emily Pan, Peter Raivio, Anders Wickbom, Johan Sjögren, Arnar Geirsson, Tomas Gudbjartsson, Igor Zindovic, Once after a full moon: acute type A aortic dissection and lunar phases, Interactive CardioVascular and Thoracic Surgery, Volume 34, Issue 1, January 2022, Pages 105–110,

Once after a full moon : acute type A aortic dissection and lunar phases

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Author: Bjursten, Henrik1; Oudin Åström, Daniel2,3; Nozohoor, Shahab1;
Organizations: 1Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
2Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
3Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
4Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark
5Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
6Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
7Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
8Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
9Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
10Research Unit of Surgery, Anesthesia, and Critical Care, University of Oulu, Oulu, Finland
11Heart Centre, Tampere University Hospital and University of Tampere, Tampere, Finland
12Department of Cardiothoracic Surgery, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
13Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
14Turku University Hospital, Turku, Finland
15Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital and Faculty of Medicine and Health, Orebro University, Orebro, Sweden
16Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA
17Department of Cardiothoracic Surgery, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: Oxford University Press, 2022
Publish Date: 2022-08-15


Objectives: Acute type A aortic dissection (ATAAD) is a rare but severe condition, routinely treated with emergent cardiac surgery. Many surgeons have the notion that patients with ATAAD tend to come in clusters, but no studies have examined these observations. This investigation was undertaken to study the potential association between the lunar cycle and the incidence of ATAAD.

Methods: We collected information on 2995 patients who underwent ATAAD surgery at centres from the Nordic Consortium for Acute Type A Aortic Dissection collaboration. We cross-referenced the time of surgery with lunar phase using a case-crossover design with 2 different definitions of full moon (>99% illumination and the 7-day full moon period).

Results: The period when the moon was illuminated the most (99% definition) did not show any significant increase in incidence for ATAAD surgery. However, when the full moon period was compared with all other moon phases, it yielded a relative risk of 1.08 [95% confidence interval (CI) 1.00–1.17, P = 0.057] and, compared to waxing moon, only the relative risk was 1.11 (95% CI 1.01–1.23, P = 0.027). The peak incidence came 4–6 days after the moon was fully illuminated.

Conclusions: This study found an overrepresentation of surgery for ATAAD during the full moon phase. The explanation for this is not known, but we speculate that sleep deprivation during full moon leads to a temporary increase in blood pressure, which in turn could trigger rupture of the aortic wall. While this finding is interesting, it needs to be corroborated and the clinical implications are debateable.

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Series: Interactive cardiovascular and thoracic surgery
ISSN: 1569-9293
ISSN-E: 1569-9285
ISSN-L: 1569-9293
Volume: 34
Issue: 1
Pages: 105 - 110
DOI: 10.1093/icvts/ivab220
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This work was supported by a Skane Regional Research Fund, ALF-funds (Government Compensation to County Councils for Costs Arising from Research and Education), University of Iceland Research Fund, Landspitali Research Fund and the Mats Kleberg Foundation.
Copyright information: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.