Patients who survive an aortic dissection often fail to receive comprehensive post-surgical follow-up care leaving them vulnerable to a lifetime of sustained risk. This is according to research published in the Journal of the American College of Cardiology (JACC), authored by Jennifer Chung (Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada) and colleagues, looking at surveillance imaging following acute type A aortic dissection.
“What we found in our study was that almost no one was receiving guideline-recommended imaging surveillance (GRIS) after dissection,” says Chung. “These patients are at ongoing risk for aortic complications, reintervention and death. It is important to know that these risks do not subside over time.”
Chung’s study examined 888 Ontarians who survived urgent aortic dissection repair between 1 April 2005 and 31 March 2018. If one survived the surgery, the mortality rate was 4% after one year, 14% at five years, and 29% at 10 years. The study also showed that the rate of surveillance imaging dropped to 21% just two years post-surgery, and at eight years, it was less than 2%.
Guidelines recommend imaging surveillance at one, six and 12 months, and then annually, following aortic dissection repair. Overall, only 14% of patients underwent surveillance at these timepoints.
Chung, who was the senior author of the study, says that unlike other similar procedures—such as endovascular aneurysm repair—patients who have undergone aortic dissection repair are “orphaned” in follow-up, unclear of who is managing their aortic care going forward.
Other factors contributing to the lack of consistent follow-up care include distance between the patient’s residence and the referral centre where they received surgery, and misconceptions surrounding the durability of the repair.
Addressing this lack in comprehensive post-surgical follow-up is why Chung has established the Thoracic Aortic Surgery Clinic within the Peter Munk Centre of Excellence in Aortic Disease.
“Our clinic is multidisciplinary—it includes a range of aortic experts, including cardiac surgeons, vascular surgeons, and interventional radiologists,” explains Chung. “We follow patients with aortic dissections and aortic aneurysm who may need ongoing imaging surveillance and possibly even surgery down the road. By providing clear and accessible follow-up, we hope to prevent future aortic catastrophe.”