Quality of Life after Surgery for Stanford Type A Aortic Dissection: Influences of Different Operative Strategies
DOI:
https://doi.org/10.1532/hsf.1738Abstract
Background: Outcome of surgery for acute Stanford type A aortic dissection extends beyond mortality and morbidity. More than one operative strategy is available but little is known regarding their influence on quality of life. This study analyzes the influence of defensive and aggressive operative strategies on the patients’ midterm quality of life (QoL).
Methods: From July 2007 to July 2010, 95 patients underwent surgery for acute Stanford type A aortic dissection in our institution. Patients who survived the procedure, gave consent to inclusion in the institution prospective registry, completed at least 2-years of follow-up protocol, and answered two quality of life questionnaires (SF-36 and WHO-QOL-BREF) were included in the study. Patients were divided into two groups according to operative strategy: defensive (DS) with replacement of the ascending aorta only, and aggressive (AS) with replacement of the ascending aorta, aortic arch with/out a frozen elephant trunk procedure. The preoperative, operative, postoperative and the midterm QoL were analyzed and compared.
Results: 39 patients were included in the study. The DS group had a shorter operative time (184 ± 54 versus 276 ± 110 minutes respectively, P = .001). The AS group had higher incidence of dialysis (31% versus 4% respectively, P = .038). The midterm QoL analysis showed a collective lower value than the normal population. In the SF-36, DS performed better in all categories but with no statistical significance. In the WHO-QOL-BREF, DS performed significantly better in the global life quality and psychological health categories
(P = .038 and .049 respectively).
Conclusion: In Stanford type A aortic dissection, adopting an aggressive surgical strategy does not improve the quality of life in midterm follow-up compared to a defensive strategy. Unless the clinical setting dictates an aggressive management strategy, a defensive strategy can be safely adopted.
References
Angermeyer MC, Kilian R, Matschinger H. 2000. WHOQOL-100 und WHOQOL-BREF. Handbuch fur die deutschsprachige Version der WHO Instrument zur Erfassung von Lebensqualitat. Gottingen: Hogrefe-Verlag.
Aristoteles. 1993. Ethica Nicomachea A. Athens: Kaktos.
David R. 2005. Measuring quality of life after surgery. Surg Innov 12:161-5.
Ellert U, Bellach M. 1999. Der Bundesgesundheitssurvey - Beschreibung einer aktuellen Normstichprobe. Gesundheitswesen 61:190-4.
Farquhar M. 1995. Definitions of quality of life: a taxonomy. J Adv Nurs 22:502-8.
George P. 2012. Questions remain about quality of life after abdominal aortic aneurysm repair. J Vasc Surg 56:520-7.
Hanestad BR, Albrektsen G. 1993. The effects of participation in a support group on self-assessed quality of life in people with insulin-dependent diabetes mellitus. Diabetes Res Clin Pract 19:163-73.
Karck M, Chavan A, Hagl C, Friedrich H, Galanski M, Haverich A. 2003. The frozen elephant trunk technique: a new treatment for thoracic aortic aneurysms. J Thorac Cardiovasc Surg 125:1550-3.
Noyez L, de Jager MJ, Marku AL. 2011. Quality of life after cardiac surgery: underresearched research. Interact Cardiovasc Thorac Surg 13:511-14.
Reece T, Green G, Kron I. 2008. Aortic Dissection. In: Cohn L, ed. Cardiac surgery in the adult. 3rd ed. New York: McGraw Hill; 1195-1222.
Truls M, Santi T, Vincenzo R. 2007. Cardiovascular surgery in the initial treatment of aortic dissection and acute aortic syndroms. In: Baglia R, Nienaber C, Isselbacher E, Eagle K, eds. Aortic dissection and related syndroms. New York: Springer Science + Business Media; 167-90.
Uchida N, Katayama K, Takahashi S, Sueda T. 2013. Endovascular stent grafting of the downstream aorta after complete arch replacement using the frozen elephant trunk technique for acute type A aortic dissection. Eur J Cardiovasc Surg 43:196.
World Health Organization Quality of Life Assessment (WHOQOL). 1998. Development and general psychometric properties. Soc Sci Med 46:1569-85.
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