Survival high after successful surgery for type A aortic dissection
Ann Arbor, MI – Survival rates three years after surgery for type A aortic dissection are “excellent,” as long as patients survive to hospital discharge, a new study suggests . The findings emphasize that in the modern-day surgical era, patients who receive surgery and come through it successfully have a good chance of surviving long term, Dr Thomas T Tsai (University of Michigan Cardiovascular Center, Ann Arbor) and colleagues write in a surgery supplement to Circulation July 4, 2006.
“This should reenergize us to try to diagnose and treat these patients as quickly as possible,” Tsai commented to heartwire. “You have a lifesaving treatment that is effective in the short and long term, so it should really light a fire under us to push forward and get better at diagnosing this earlier, implementing treatment more quickly, and educating the lay public about the importance of coming to the hospital when they have symptoms.”
According to the Tsai et al, this new analysis from the International Registry of Aortic Dissection (IRAD) database examined 303 patients who survived to hospital discharge after being treated at 21 medical centers in 11 countries between 1996 and 2003. As such, it represents a much more contemporary picture of aortic dissection; previous observational studies have had to collect data over much longer periods of time and as such do not as closely reflect current techniques and management.
“What’s new is that, given the contemporary care that we give patients internationally, if a patient comes to a hospital and is treated for their dissection, as long as they survive to hospital discharge, they can do quite well,” Tsai said. “In our study, more than 90% of patients were alive at three years, and given the catastrophic nature of the disease, that’s encouraging.”
As Tsai et al report, 90.1% of the cohort was treated surgically, while 9.9% were managed medically, either because they refused surgery or had major comorbidities. After three years of follow-up, 90.5% of the surgically treated patients had survived, compared to 63.7% of medically treated patients. Patients who died were more likely to have had preexisting atherosclerosis and to have undergone prior cardiac surgery. “If people have preexisting comorbidities, even if you fix the underlying problem, they still have underlying atherosclerosis. They are still more likely than patients without CAD to die of a heart attack. It’s really saying that while the surgical site may be well protected, you can’t revert their other comorbidities.”
Tsai emphasized that surgery is the standard of care for aortic-dissection patients; what was surprising about the IRAD analysis is that even if patients did not undergo surgery, as long as they were strong enough to survive hospital discharge, the chances of surviving three years “were not so bad,” Tsai said. This implies that nonsurgical aortic-dissection survivors “deserve and probably benefit from ongoing medical therapy,” the authors conclude.