Surveillance Imaging Following Acute Type A Aortic Dissection.
J Am Coll Cardiol
; 78(19): 1863-1871, 2021 11 09.
Article
em En
| MEDLINE
| ID: mdl-34696957
ABSTRACT
BACKGROUND:
Survivors of acute type A aortic dissection (ATAAD) repair remain at risk for long-term complications. Guidelines recommend postoperative imaging surveillance, but adherence is uncertain.OBJECTIVES:
The aim of this study was to define the real-world frequency of postoperative imaging and characterize long-term outcomes of ATAAD.METHODS:
Population-based administrative health databases for Ontario, Canada, were linked to identify patients who underwent ATAAD repair and survived at least 90 days. Guideline-directed imaging surveillance (GDIS) was defined as undergoing a computed tomographic or magnetic resonance imaging scan at 6 and 12 months postoperatively and then annually thereafter. Multivariable time-to-event analysis explored the associations between GDIS and all-cause mortality and reintervention.RESULTS:
A total of 888 patients who survived urgent ATAAD repair between April 1, 2005, and March 31, 2018, were included. Median follow-up after ATAAD repair was 5.2 years (interquartile range 2.4-7.9 years). A total of 14% patients received GDIS throughout follow-up. At 6 years, 3.9% of patients had received GDIS. The mortality rate was 4% at 1 year, 14% at 5 years, and 29% at 10 years. Incidence of aortic reintervention was 3% at 1 year, 9% at 5 years, and 17% at 10 years; the majority of these were urgent (68%), and they carried a 9% 30-day mortality rate. Greater adherence to GDIS was associated with mortality (hazard ratio 1.08; 95% confidence interval 1.05-1.11) and reintervention (hazard ratio 1.04; 95% confidence interval 1.01-1.07).CONCLUSIONS:
Adherence to GDIS following ATAAD repair is poor, while long-term mortality and reinterventions remain substantial. Further research is needed to determine if guidelines should be modified.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Aneurisma Aórtico
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Complicações Pós-Operatórias
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Reoperação
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Procedimentos Cirúrgicos Vasculares
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Imageamento por Ressonância Magnética
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Tomografia Computadorizada por Raios X
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Efeitos Adversos de Longa Duração
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Dissecção Aórtica
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Prognostic_studies
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Screening_studies
Limite:
Female
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Humans
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Male
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Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Am Coll Cardiol
Ano de publicação:
2021
Tipo de documento:
Article