Surveillance Imaging Following Acute Type A Aortic Dissection

J Am Coll Cardiol. 2021 Nov 9;78(19):1863-1871. doi: 10.1016/j.jacc.2021.08.058. Epub 2021 Oct 22.

Abstract

Background: Survivors of acute type A aortic dissection (ATAAD) repair remain at risk for long-term complications. Guidelines recommend postoperative imaging surveillance, but adherence is uncertain.

Objectives: The aim of this study was to define the real-world frequency of postoperative imaging and characterize long-term outcomes of ATAAD.

Methods: Population-based administrative health databases for Ontario, Canada, were linked to identify patients who underwent ATAAD repair and survived at least 90 days. Guideline-directed imaging surveillance (GDIS) was defined as undergoing a computed tomographic or magnetic resonance imaging scan at 6 and 12 months postoperatively and then annually thereafter. Multivariable time-to-event analysis explored the associations between GDIS and all-cause mortality and reintervention.

Results: A total of 888 patients who survived urgent ATAAD repair between April 1, 2005, and March 31, 2018, were included. Median follow-up after ATAAD repair was 5.2 years (interquartile range: 2.4-7.9 years). A total of 14% patients received GDIS throughout follow-up. At 6 years, 3.9% of patients had received GDIS. The mortality rate was 4% at 1 year, 14% at 5 years, and 29% at 10 years. Incidence of aortic reintervention was 3% at 1 year, 9% at 5 years, and 17% at 10 years; the majority of these were urgent (68%), and they carried a 9% 30-day mortality rate. Greater adherence to GDIS was associated with mortality (hazard ratio: 1.08; 95% confidence interval: 1.05-1.11) and reintervention (hazard ratio: 1.04; 95% confidence interval: 1.01-1.07).

Conclusions: Adherence to GDIS following ATAAD repair is poor, while long-term mortality and reinterventions remain substantial. Further research is needed to determine if guidelines should be modified.

Keywords: aortic dissection; computed tomography; magnetic resonance imaging.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aneurysm, Dissecting* / epidemiology
  • Aneurysm, Dissecting* / surgery
  • Aortic Aneurysm* / diagnostic imaging
  • Aortic Aneurysm* / etiology
  • Aortic Aneurysm* / surgery
  • Female
  • Guideline Adherence
  • Humans
  • Long Term Adverse Effects* / diagnosis
  • Long Term Adverse Effects* / etiology
  • Long Term Adverse Effects* / mortality
  • Long Term Adverse Effects* / surgery
  • Magnetic Resonance Imaging* / methods
  • Magnetic Resonance Imaging* / statistics & numerical data
  • Male
  • Middle Aged
  • Needs Assessment
  • Ontario / epidemiology
  • Patient Care Planning / standards
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / etiology
  • Postoperative Complications* / mortality
  • Postoperative Complications* / surgery
  • Postoperative Period
  • Reoperation* / adverse effects
  • Reoperation* / methods
  • Reoperation* / mortality
  • Tomography, X-Ray Computed* / methods
  • Tomography, X-Ray Computed* / statistics & numerical data
  • Vascular Surgical Procedures / adverse effects*
  • Vascular Surgical Procedures / methods