Abstract
Background Acute Type A aortic dissection can be physically and mentally stressful with little known about survivors' postrepair activity levels, exercise habits, and quality of life (QOL). This study was aimed to describe pre- and postdissection changes regarding exercise, understand physician recommendations, quantify use of cardiac rehabilitation, and assess QOL in dissection survivors. Methods A total of 295 acute Type A aortic dissection survivors were surveyed about exercise, cardiac rehabilitation, QOL, sexual activity, and posttraumatic stress disorder (PTSD) with 137 (46%) respondents. Results Respondents were less likely to participate in competitive athletics after than before dissection (1/131 [0.76%] vs. 26/131 [20%], p [McNemar test] < 0.0001) or lift heavy objects (11/111 [9.9%] vs. 41/111 [37%], p < 0.0001). Forty-eight of 132 respondents (36%) did not participate in cardiac rehabilitation. Compared with general population norms, respondents reported lower median QOL physical component scores (40 [26, 51; 15th, 85th percentile], p < 0.0001); these were lower in respondents who did not exercise (Hodges–Lehmann [HL; 95% confidence interval (CI)]: –6.8 [–11, –2.4], p = 0.002), limited sexual activity (–8.0 [–13, –4.3], p = 0.0002), or screened positive for PTSD (–10 [–14, –5.3], p = 0.0002). Median mental component scores were similar to general population norms (HL [95% CI]: 55 [34, 61], p = 0.24) but were lower among respondents who did not exercise (–4.2 [–7.8, –1.0], p = 0.01), limited sexual activity (–5.5 [–10, –1.8], p = 0.003), or screened positive for PTSD (–16 [–22, –10], p < 0.0001). Conclusion Physicians should prescribe cardiac rehabilitation, encourage appropriate exercise, promote resumption of sexual activity, and identify and treat PTSD after surgery for acute Type A aortic dissection.
Highlights
Acute Type A aortic dissection is life-threatening with high short- and long-term morbidity and mortality,1 requiring expeditious surgery.2 The sudden nature of the dissection causes patients to associate the dissection with coincident activities as precipitating sources of hemodynamic stress
Respondents were less likely to participate in competitive athletics after than before dissection (1/131 [0.76%] vs. 26/131 [20%], p [McNemar test] < 0.0001) or lift heavy objects (11/111 [9.9%] vs. 41/111 [37%], p < 0.0001)
Compared with general population norms, respondents reported lower median quality of life (QOL) physical component scores (40 [26, 51; 15th, 85th percentile], p < 0.0001); these were lower in respondents who did not exercise (Hodges–Lehmann [HL; 95% confidence interval (CI)]: –6.8 [–11, –2.4], p 1⁄4 0.002), limited sexual activity (–8.0 [–13, –4.3], p 1⁄4 0.0002), or screened positive for posttraumatic stress disorder (PTSD) (–10 [–14, –5.3], p 1⁄4 0.0002)
Summary
Acute Type A aortic dissection is life-threatening with high short- and long-term morbidity and mortality, requiring expeditious surgery. The sudden nature of the dissection causes patients to associate the dissection with coincident activities as precipitating sources of hemodynamic stress. Both dissection survivors and their physicians often express concern regarding exercise despite lack of evidence, supporting the leap from association to causation This uncertainty and a paucity of data on the exercise habits of dissection patients before and after repair has made it difficult to counsel patients postoperatively.. In a cohort of patients who survived surgery for acute Type A aortic dissection, we sought to (1) compare level of competitive athletic participation, strength training exercise, and lifting of heavy objects before and after repair; (2) evaluate consistency of physician recommendations regarding exercise after repair; (3) understand use of postoperative cardiac rehabilitation; (4) describe patientreported physical and mental QOL after repair; and (5) assess the association of QOL with exercise, cardiac rehabilitation, sexual activity, and posttraumatic stress disorder (PTSD). Methods A total of 295 acute Type A aortic dissection survivors were surveyed about exercise, cardiac rehabilitation, QOL, sexual activity, and posttraumatic stress disorder (PTSD) with 137 (46%) respondents
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