video: A new study from the Peter Munk Cardiac Centre reveals a lack of comprehensive post-surgical follow-up care for patients who survive an aortic dissection, despite ongoing risk of complications and death. Senior author of the study Dr. Jennifer Chung, cardiovascular surgeon, Peter Munk Cardiac Centre, UHN explains the multidisciplinary solution to providing these patients with the lifelong care they need. view more
Credit: Peter Munk Cardiac Centre
Toronto (Oct. 26, 2021) – A new study from the Peter Munk Cardiac Centre reveals that patients who survive an aortic dissection receive a lack of comprehensive post-surgical follow-up care leaving them vulnerable to a lifetime of sustained risk. A dedicated aortic clinic has been created at the Peter Munk Cardiac Centre to provide patients with the life-long follow-up care they require.
“What we found in our study was that almost no one was receiving guideline recommended imaging surveillance (GRIS) after dissection,” says Dr. Jennifer Chung, Cardiovascular Surgeon, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network. “These patients are at ongoing risk for aortic complications, reintervention, and death. What’s particularly alarming is that these risks do not subside over time.”
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. Surviving an aortic dissection carries a lifetime of sustained risk.
Dr. Chung’s study, published Oct. 22 in the Journal of the American College of Cardiology, followed 888 Ontarians who survived urgent aortic dissection repair between April 1, 2005 and March 31, 2018. 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 also showed that GRIS dropped to 21 per cent just 2 years post-surgery, and at eight years, it was less than two per cent.
Dr. Chung, who was 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.
ddressing this lack in comprehensive post-surgical follow-up is why Dr. Chung has established the aortic 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 interveinal 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. By providing clear and accessible follow-up, we hope to prevent future aortic catastrophe.”
Key Findings
The study followed 888 Ontarians who survived urgent aortic dissection repair between April 1, 2005 and March 31, 2018. Median age of the cohort was 61 years (51-71), and 70% were men; 87% lived in urban areas.
Mortality rate post aortic dissection repair:
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4 per cent after 1 year
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14 per cent at 5 years
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29 per cent at 10 years
Instance of re-intervention (urgent or elective surgery):
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3 per cent at 1 year
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9 per cent at 5 years
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17 per cent at 10 years
68 per cent of these cases were urgent and carried a 9 per cent 30-day mortality rate.
Re-intervention or death for the entire cohort was:
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6 per cent at 1 year
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21 per cent at 5 years
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39 per cent at 10 years
Guidelines recommend imaging surveillance at 1, 6, and 12 months, and then annually, following aortic dissection repair. Overall, only 14 per cent of patients followed the guidelines.
About the Peter Munk Cardiac Centre
The Peter Munk Cardiac Centre (PMCC) opened in 1997 through the generous support of Peter and Melanie Munk. A global leader in cardiovascular care, with internationally-renown medical expertise, PMCC has some of the best patient outcomes in the world and is home to many world firsts that span cardiac and vascular research and discoveries. Canada’s premier cardiac centre is part of the University Health Network (UHN) and located at the Toronto General Hospital in Toronto, Ontario, Canada. For more information, visit http://www.petermunkcardiaccentre.ca
About the University Health Network
University Health Network consists of Toronto General, recently ranked the #4 Hospital in the World according to Newsweek Magazine, and Toronto Western Hospital, the Princess Margaret Cancer Centre, Toronto Rehabilitation Institute, and the Michener Institute of Education at UHN. The scope of research and complexity of cases at University Health Network has made it a national and international source of discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto.
http://www.uhn.ca
Contact
Courtney Mahrt, Senior Public Affairs Associate
Peter Munk Cardiac Centre
Phone: 437-217-2819
Email: courtney.mahrt@uhn.ca
Journal
Journal of the American College of Cardiology
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Surveillance Imaging Following Acute Type A Aortic Dissection
Article Publication Date
22-Oct-2021
COI Statement
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.