From Court to Couch: Exercise and Quality of Life after Acute Type A Aortic Dissection

Selena R Pasadyn; Eric E Roselli; Amanda S Artis; Cassandra L Pasadyn; Dermot Phelan; Eugene H Blackstone

doi:10.1055/s-0041-1731403

From Court to Couch: Exercise and Quality of Life after Acute Type A Aortic Dissection

Aorta (Stamford). 2021 Oct;9(5):171-179. doi: 10.1055/s-0041-1731403. Epub 2021 Oct 5.

Authors

Selena R Pasadyn¹, Eric E Roselli^{1

2}, Amanda S Artis³, Cassandra L Pasadyn¹, Dermot Phelan^{1

4}, Eugene H Blackstone^{1

2

3}

Affiliations

¹ Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
² Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
³ Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
⁴ Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

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.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Grants and funding

Funding This study was supported in part by the Drs. Sidney and Becca Fleischer, Heart and Vascular Education Chair, and The Stephens Family Endowed Chair in Cardiothoracic Surgery.