Quality of life following surgical repair of acute type A aortic dissection: a systematic review

Abstract

Background The outcomes of surgery for acute Stanford Type A aortic dissection (ATAAD) extend beyond mortality and morbidity. The aim of this systematic review was to summarise the literature surrounding health related quality of life (HR-QOL) following ATAAD, compare the outcomes to the standardised population, and to assess the impact of advanced age on HRQOL outcomes following surgery. Methods A systematic review of studies after January 2000 was performed to identify HR-QOL in patients following surgery for ATAAD. Electronic searches of three databases were performed and clinical studies extracted by two independent reviewers. Strict inclusion and exclusion criteria were applied. Quality appraisal was conducted utilizing predefined criteria on pilot forms. HR-QOL results were synthesized through a narrative review of included studies. Results There was significant attrition in HR-QOL of patients following surgery for ATAAD. Outcomes fared worse when compared to an age adjusted normative population. Of note, elderly patients were physically vulnerable, whereas younger populations may be more mentally vulnerable to postoperative sequalae. The included studies were quite heterogeneous in their study designs, methods, HR-QOL measures reported and follow up time-frames which limited direct comparison between studies. Conclusion HR-QOL outcomes are adversely affected when compared to preoperative status and physical health demonstrates significant attrition over time. HR-QOL outcomes are worse off when compared to an age matched general population. In terms of age, advancing age is associated with worse physical component scores but emotional health may fare better than younger patients.

What Really Matters to Survivors of Acute Type A Aortic Dissection—A Survey of Patient-Reported Outcomes in the Dutch National Aortic Dissection Advocacy Group

“…In line with the literature, our patients reported changes in daily life after aortic surgery [3]. There was a significant decline in physical fitness, with half of the respondents reporting a worsened state than that prior to surgery.…”

“…Cardiothoracic surgery studies and surveys-using the above-mentioned questionnaires-often do not use the endpoints/questions that are most meaningful to patients in their daily lives [3]. Unfortunately, the correlation between the lowest complication rates and the highest HRQoL are not always consistent [12].…”

“…It is important to understand that not only early complications, such as mortality and short-term morbidity (<30 days), need to be measured, but also a wide range of adverse events with long-term effects (such as stroke, renal failure, heart failure, cognitive dysfunction, etc. ), as these also have a serious impact on the quality of life of surviving patients [3]. Most of the aforementioned complications are hard outcomes [4], collected in quality assurance registers, to measure or benchmark surgical success.…”

The Long-Term Outcome and Quality of Life after Replacement of the Ascending Aorta

“…Although several studies have compared short- and long-term postoperative surgical outcomes, such survival and complications, there are only a few studies in the literature that compares the postoperative QoL of the physical and psychological status after replacement of the AA [ 8 , 11 , 12 , 13 ]. Most available studies reported the outcome after acute type A dissection [ 14 , 15 , 16 , 17 ]. Some other studies have been performed after interventions of the descending and thoracoabdominal aorta [ 18 , 19 , 20 , 21 , 22 ].…”

How to help aortic dissection survivors with recovery?: A health promotion program based on the comprehensive theory of health behavior change and literature review

“…[4] However, AD survivors still face many challenges, such as postoperative complications, impairment of physical function, decreased quality of life, and psychological trauma. [5][6][7][8] Therefore, the health promotion of AD is one of the important means to help them recover from the disease.…”