Study shows high survival for patients with torn aortas who get surgery

Nearly three years ago, actor John Ritter collapsed on the set of his sitcom, the victim of a rare but often deadly condition called aortic dissection - a tear in the largest blood vessel in the body. His death brought international attention to the catastrophic condition, which strikes 10,000 Americans a year and is often linked to high blood pressure and genetic disorders.

Now, researchers have published some rare good news about aortic dissection, showing that 90 percent 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 are published in a supplement to the journal Circulation.

The study, performed by an international team led by specialists at the University of Michigan Cardiovascular Center, involved data from 303 patients. All 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.

It's a unique study looking at survival among Type A aortic dissection patients who live through their initial crisis. The authors say the results offer hope that with proper rapid diagnosis and successful surgery, more patients can survive.

However, 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 percent in-hospital death rate that includes a 25 percent risk of death during surgery. But less is known about the fate of those who survive long enough to leave the hospital.

"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," says 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."

Tsai and senior author Kim Eagle, M.D., co-director of the U-M CVC, conducted the research with colleagues from the International Registry of Aortic Dissection, or IRAD, using data on patients treated at 21 medical centers in 11 countries. U-M is the coordinating center for IRAD.

"Aortic dissection is still very much a lethal health crisis, with mortality approaching 2 percent per hour. But these results show we're doing a pretty good job in helping patients after they weather the storm of diagnosis and surgery," says Eagle.

The new study drew its patients from a group of 885 Type A aortic dissection patients who came or were transferred to IRAD centers. Nearly 30 percent of the Type A patients died before leaving the hospital, and long-term follow-up data were available on many of the 617 who left the hospital after surgical or non-surgical treatment. The patients included in the final analysis were treated at eight IRAD centers that compiled long-term follow-up data on most of their patients.