Excellent Outlook for Aortic Dissection Survivors

Researchers at the Cardiovascular Center of the University of Michigan (U-M, Ann Arbor, USA) examined data from 303 patients--treated at 21 medical centers in 11 countries--listed in the International Registry of Aortic Dissection (IRAD). The patients were treated in the late 1990s and early 2000s for the most serious form of aortic dissection, called type A, which occurs in the upper part of the aorta near the heart. The study found that 90% of patients who survive emergency surgery and hospitalization for its most serious form will still be alive three years later; those without pre-existing heart and blood vessel problems were even more likely to survive. The findings were published in a supplement to the July 4, 2006, issue of the journal Circulation.

The biggest impact on survival rates was made by underlying health problems--such as hypertension (72%), atherosclerosis (25%), and previous cardiovascular surgery (13%)--and not any aspect of in-hospital complications. In fact, patients who had atherosclerosis or previous cardiovascular surgery had twice the risk of dying in the three-year follow-up period as patients without these characteristics.

Because aortic dissection is rare and its symptoms can mimic those of a heart attack, it is often not diagnosed or treated quickly, contributing to a 30% in-hospital death rate that includes a 25% risk of death during surgery. The IRAD team is working to improve the screening tools that might be used to determine who is at high risk of an aortic dissection. Currently, people with Marfan syndrome, connective tissue disorders, long-term blood pressure problems, and some other conditions are known to have an elevated risk.

"Clearly, this is one of those diseases where if you catch it early you can save lives in the hospital, and with successful surgery your outlook after discharge can look quite good,” said lead author Thomas Tsai, M.D., a cardiovascular research fellow at the U-M Medical School. "Of course, those who do survive will have a diagnosis for life of aortic disease, and will need medication and aggressive monitoring of their aorta.”



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