title: Quality of life after intervention on the thoracic aorta.
abstract: Surgery on the thoracic aorta is challenging and historically associated with significant mortality and morbidity. In recent times, there has been increased emphasis on the importance of health-related quality of life (HRQOL) measures. It is seen as a development beyond isolated markers of outcome such as operative mortality and is particularly applicable to aortic surgery given the number of asymptomatic patients operated on (for prognostic grounds), and rapidly advancing endovascular technologies which require proper assessment. This systematic review provides an outline of all available literature detailing HRQOL in patients receiving intervention (both open and endovascular) on the thoracic aorta. In total, 30 studies were identified encompassing 4746 patients undergoing a variety of procedures from aortic root replacement to thoracoabdominal aortic aneurysm repair. While there were deficiencies in the underlying literature such as lack of baseline HRQOL assessment, the majority of the studies confirm that HRQOL after major aortic surgery (including on the elderly and in emergency situations) is acceptable and compares well to matched general populations. Strategies for improving the HRQOL in aortic surgery are summarized and include the need for surgeons to plan cerebral protection methods more carefully and to develop operative strategies to avoid reoperation or reintervention, as this is associated with deterioration of long-term HRQOL. Randomized studies measuring baseline and follow-up HRQOL at specific set points are needed. Innovative research methods could be employed in future studies with the aim of correlating HRQOL with imaging or physiological/inflammation biomarkers, or other end points such as aortic stiffness or wall shear stress to characterize disease progression and prognosis.
authors: Department of Surgery and Cancer, Imperial College London, London, UK omarjarral@gmail.com.
authors: Omar A
authors: OA
authors: Jarral
authors: Department of Surgery and Cancer, Imperial College London, London, UK.
authors: Emaddin
authors: E
authors: Kidher
authors: Department of Surgery and Cancer, Imperial College London, London, UK.
authors: Vanash M
authors: VM
authors: Patel
authors: Department of Surgery and Cancer, Imperial College London, London, UK.
authors: Bao
authors: B
authors: Nguyen
authors: Department of Surgery and Cancer, Imperial College London, London, UK.
authors: John
authors: J
authors: Pepper
authors: Department of Surgery and Cancer, Imperial College London, London, UK.
authors: Thanos
authors: T
authors: Athanasiou
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life
keywords: Aortic arch; Aortic root; Ascending aorta; Descending thoracic aorta; Outcomes; Quality of life; Thoracoabdominal aorta