New study reveals heart patients "orphaned" following aortic dissection repair despite ongoing risk of complications and death

Newswise — Toronto (Oct. 27, 2021) – A new study from the Peter Munk Cardiac Centre reveals that 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. 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. It is important to know ​​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, examined ​​888 Ontarians who survived urgent aortic dissection repair between April 1, 2005 and March 31, 2018. If one survives the surgery, ​the ​​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 ​the rate of surveillance ​imaging ​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 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 Dr. Chung has established the Thoracic Aortic Surgery Clinic ​​​​within the 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. 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 per cent were men; 87 per cent lived in urban areas.

Mortality rate post aortic dissection repair:

• 4 per cent after 1 year
• 14 per cent at 5 years
• 29 per cent at 10 years

Instance of re-intervention (urgent or elective surgery):

• 3 per cent at 1 year
• 9 per cent at 5 years
• 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:

• 6 per cent at 1 year
• 21 per cent at 5 years
• 39 per cent at 10 years

Guidelines recommend imaging surveillance at one, six and 12 months, and then annually, following aortic dissection repair. Overall, only 14 per cent of patients followed the guidelines.

Read the full paper

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: www.petermunkcardiaccentre.ca

About University Health Network

University Health Network consists of Toronto General and Toronto Western Hospitals, 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 for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in arthritis, 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. For more information, visit: www.uhn.ca

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