Why I Didn't Wait - The Statistics for Dissection

I was painting inside my house last summer when I suddenly felt strange. I climbed off a short ladder, and realized my heart was pounding. I tried deep breathing, laying down and finally a cold shower. My heart was still going nuts and I could see it beating under my skin. Went to the ER where my heart rate was 220, and after a couple of days of tests, I was diagnosed with a 5.2 cm TAA. The cardiologist assigned to me in the hospital has a stellar reputation in the community, and he decided I should see him for followup in 4 months to remeasure the aneurysm. While in the hospital still, I googled the surgery I would require and found that while the hospital I was in had a "better than average" rating for aneurysm repair, the hospital where my sister works as a nurse had a "best rating".  I made an appointment to consult with the cardiologist at that hospital. A new CT scan was done and the measurement was updated to 5.3 cm.  He said he wanted me to return in three months. He told me I was a candidate for valve sparing surgery and that one of the other surgeons there would be the one to do my surgery.  I'd already read enough to know that for females, surgery is performed now more often performed when the aneurysm reaches 5.0 cm rather than the 5.5 c.m. measurement for male patients and I was so close! I made another appointment, with the guy who would actually be operating on me. I presented him with some studies, and he had actually co-authored one of the papers. He said I met another criteria for surgery, which was that my aneurysm was double the diameter of my aorta. I was moving out of state and there's a shortage of doctors in my new (small) town. I also didn't want to be crossing the desert and end up in an ER with an unknown surgeon on call when I'd done homework and found the best. He still felt that I was overly anxious, but agreed to schedule me. I had my surgery within a month, and I'm so glad I did! The anxiety was in the past and I had fairly easy recovery, out of the hospital on day five. 

I wanted to share the paper I read that brought about my decision not to wait.  When I read that 40% of the dissections occurred at diameters smaller than 5.0 cm, that cinched it for me. 

https://www.valleyheartandvascular.com/Thoracic-Aneurysm-Program/Risk-Stratification.aspx

And: Volume 116, Issue 10, September 2007, Pages 1120-1127

Aortic diameter =5.5 cm is not a good predictor of type A aortic dissection: Observations from the International Registry of Acute Aortic Dissection (IRAD)(Article)

Pape, L.A., Tsai, T.T., Isselbacher, E.M., Oh, J.K., O'Gara, P.T., Evangelista, A., Fattori, R., Meinhardt, G., Trimarchi, S., Bossone, E., Suzuki, T., Cooper, J.V., Froehlich, J.B., Nienaber, C.A., Eagle, K.A.

aUniversity of Massachusetts Medical School, Worcester, MA, United States

bUniversity of Michigan, Ann Arbor, MI, United States

cMassachusetts General Hospital, Boston, MA, United States

 Abstract

BACKGROUND - Studies of aortic aneurysm patients have shown that the risk of rupture increases with aortic size. However, few studies of acute aortic dissection patients and aortic size exist. We used data from our registry of acute aortic dissection patients to better understand the relationship between aortic diameter and type A dissection.

METHODS AND RESULTS - We examined 591 type A dissection patients enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2005 (mean age, 60.8 years). Maximum aortic diameters averaged 5.3 cm; 349 (59%) patients had aortic diameters <5.5 cm and 229 (40%) patients had aortic diameters <5.0 cm. Independent predictors of dissection at smaller diameters (<5.5 cm) included a history of hypertension (odds ratio, 2.17; 95% confidence interval, 1.03 to 4.57; P=0.04), radiating pain (odds ratio, 2.08; 95% confidence interval, 1.08 to 4.0; P=0.03), and increasing age (odds ratio, 1.03; 95% confidence interval, 1.00 to 1.05; P=0.03). Marfan syndrome patients were more likely to dissect at larger diameters (odds ratio, 14.3; 95% confidence interval, 2.7 to 100; P=0.002). Mortality (27% of patients) was not related to aortic size.

CONCLUSIONS - The majority of patients with acute type A acute aortic dissection present with aortic diameters <5.5 cm and thus do not fall within current guidelines for elective aneurysm surgery. Methods other than size measurement of the ascending aorta are needed to identify patients at risk for dissection. © 2007 American Heart Association, Inc.

I was 58 when I had my surgery six months ago and I'm doing well! I had no complications. The scar is fading, and I have no limitations on what I can do. I do take blood pressure medicine and one to regulate my heart rate a bit. I need to lose weight still, but I'm working on that. My state of mind is so much better than it was before the surgery, and I can pick up my two-year-old granddaughter, which wasn't allowed prior to surgery. Life is great!

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