Patient population ‘orphaned’ following aortic dissection repair, despite ongoing risk

Dr. Jennifer Chung, the study’s senior author, is a cardiovascular surgeon at UHN’s Peter Munk Cardiac Centre. (Photo: Tim Fraser)

A new study from UHN’s Peter Munk Cardiac Centre (PMCC) reveals that patients who survive an aortic dissection often fail to receive comprehensive post-surgical follow-up care.

An aortic dissection occurs when blood rushes through a tear in the aorta, causing it to split or dissect. This life-threatening event requires emergency surgery, and surviving an aortic dissection carries a lifetime of sustained risk.

“It’s fabulous that we’re able to provide this life-saving surgery,” says Dr. Jennifer Chung, a cardiovascular surgeon at PMCC and senior author of the study. “But the question is what happens to patients after they go home?

“What we found in our study was that almost no one was receiving guideline-recommended imaging surveillance after dissection.”

In the study of 888 Ontarians​​​​​ who survived urgent aortic dissection repair between April 1, 2005 and March 31, 2018, if one survives the surgery, the post-surgery mortality rate was four per cent after one year, 14 per cent at five years, and 29 per cent at 10 years. The study was published October 22 in the Journal of the American College of Cardiology.

The study also showed that guideline-recommended imaging surveillance dropped to 21 per cent just two years post-surgery, and at eight years it was less than two per cent.

“These patients are at ongoing risk for aortic complications, reintervention, and death,” Dr. Chung says. “What’s particularly alarming is that these risks do not subside over time.”

‘Orphaned’ patient population

Dr. Chung 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 included distance between the patient’s residence and the referral centre where they received surgery, and misconceptions surrounding the durability of the repair.

“Dr. Chung’s team shows that these patients have very poor follow-up,” says Dr. Maral Ouzounian, a cardiovascular surgeon at PMCC. “For patients with aortic disease, especially aortic dissection, life-long follow ​​up is essential.”

A multidisciplinary solution

To address the lack in comprehensive post-surgical follow-up care, Dr. Chung has established a new aortic clinic, part of 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 Dr. Chung. “We follow patients with aortic dissections and aortic aneurysm who may need ongoing imaging surveillance and possibly even surgery down the road.”

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