Modern surgical techniques increase survival rates after aortic dissection
Study demonstrates how patients can survive a life-threatening rupture to the aorta with fewer neurological complications
Aortic dissection is a life-threatening condition which occurs when the internal arterial wall of the aorta ruptures causing blood to collect between the internal arterial walls. Patients’ symptoms are similar to those after a stroke and the mortality rate is around one to two percent per hour. ‘In addition to rapid and accurate diagnosis, the correct surgical technique is decisive for successful treatment,’ says PD Dr. Frank Harig, Senior Consultant at the Department of Cardiac Surgery (Director: Prof. Dr. Michael Weyand) at Universitätsklinikum Erlangen. Harig researched optimal therapies for aortic dissection over the course of ten years and has now published the results in the International Journal of Surgery & Surgical Techniques.
The main symptoms of the condition are severe stabbing pains in the back, often after strenuous activities such as shovelling snow or chopping wood, circulatory collapse or a wide range of neurological complications. The symptoms are similar to those during a stroke, such as paralysis on one side. ‘These neurological symptoms in particular were the reason behind conducting more detailed research about improved surgical techniques,’ says heart surgeon Dr. Harig, who was able to demonstrate that the carotid arteries are also affected in up to 25 percent of cases, reducing the flow of blood to the brain.
This results in neurological symptoms in as many as eleven percent of patients before surgery, and eight percent of these involve paralysis on one side of the body. Men are more than twice as likely to be affected as women. Thanks to improved surgical techniques, around 33 percent of these pre-operative symptoms are reversible. The frequency of post-operative neurological deficits has been reduced by around 50 percent, so that permanent neurological damage has only been observed in around ten percent of patients over the last few years.
The surgical techniques involved include special cannulation techniques for the arteries supplying the brain, monitoring the oxygen saturation of specific parts of the brain as well as slightly lowering patients’ body temperature during surgery. Without surgery, most patients (around 60 percent) die within two days, 33 percent due to a tear in a blood vessel, 15 percent due to neurological damage and 12 percent due to disturbed blood flow to the intestines or kidneys. In around eight percent of cases, fluid collects in the heart sac.
The survival rates after surgery have increased considerably from 70 percent to currently 85 percent. Dr. Harig concludes: ‘In future, patients will still have to seek medical attention as quickly as possible, so that doctors can make the right diagnosis – usually by means of computer tomography. Doctors in outpatients’ departments, regardless of whether they are neurologists, orthopaedic specialists or other specialists, should also consider the involvement of the aorta if they are presented with a patient who has severe and sudden back pain.’
‘F. Harig et al. Optimizing Outcome in Stanford Type A Dissection – A 10 Year Analysis Focusing on Surgical Techniques and Neurological Outcome. International Journal of Surgery & Surgical Techniques 2019, 3(1):000132’.
PD Dr. Frank Harig
Phone: +49 9131 8537066