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Canadian Journal of Cardiology

IMAGING SURVEILLANCE FOLLOWING ACUTE TYPE A AORTIC DISSECTION: A POPULATION-BASED COHORT STUDY

      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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