BACKGROUND
Patients who survive repair of acute type A aortic dissection (ATAAD) remain at risk
of aneurysmal degeneration and rupture of the residual native aorta. Guidelines recommend
regular post-operative imaging surveillance in this population, but adherence to this
recommendation and its clinical benefit are uncertain. We sought to define the real-world
frequency of post-operative imaging and characterize its association with long-term
outcomes.
METHODS AND RESULTS
Population-based administrative health databases for Ontario, Canada, were linked
to identify patients who underwent ATAAD repair and survived at least 90 days. Full
guideline-directed imaging surveillance (GDIS) was defined as having a CT or MRI scan
at 6 and 12 months post-operatively, and then annually thereafter. Multivariable time-to-event
analysis was used to explore the associations between GDIS and all-cause mortality,
as well as aortic reintervention. A total of 888 patients who survived urgent ATAAD
repair between April 1, 2005 and March 31, 2018 were included. Median follow-up duration
after ATAAD repair was 5.2 years (IQR 2.4-7.9). A total of 14% of patients received
GDIS during their entire follow-up. At 6 years, only 3.9% of patients had received
GDIS. For those who survived the first 90 days, survival rate was 96% at 1 year, 86%
at 5 years and 71% at 10 years. Incidence of re-intervention was 3% at 1 year, 9%
at 5 years and 17% at 10 years. For every 10% increase in the proportion of time a
person was undergoing GDIS, increased risks of mortality (HR 1.08, 95% CI 1.05-1.11)
and reintervention (HR 1.04, 95% CI 1.01-1.07) were observed.
CONCLUSION
Adherence to GDIS following ATAAD repair is poor in Ontario and imaging surveillance
appears to be used selectively only in those with more aggressive disease and at higher
risk for poor outcomes. Further research is needed to understand if this approach
is reasonable and if guidelines should be modified.
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© 2021 Published by Elsevier Inc.
