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Surveillance Imaging Following Acute Type A Aortic Dissection.

Authors :: An KR
de Mestral C
Tam DY
Qiu F
Ouzounian M
Lindsay TF
Wijeysundera HC
Chung JC
Source :: Journal of the American College of Cardiology [J Am Coll Cardiol] 2021 Nov 09; Vol. 78 (19), pp. 1863-1871. Date of Electronic Publication: 2021 Oct 22.
Publication Year :: 2021
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. Competing Interests: Funding Support and Author Disclosures This study was supported by the Cardiovascular Surgery Division at the Toronto General Hospital. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)