Acute Type A Aortic Dissection: Post-Repair Quality of Life and Its Association With Post-Traumatic Stress Disorder, Exercise and Sexual Activity

Introduction: Aortic dissection (AD) classically presents with abrupt onset of symptoms immediately followed by major emergency surgery. This can be physically and mentally traumatic. Little is known about the post-repair Quality of Life (QOL) of patients and its association with exercise, post-traumatic stress disorder (PTSD), and sexual activity. Our objective was to describe these associations. Methods: There were 295 identified patients who survived acute type A aortic dissection repair. All were surveyed and 132 responded. Included was the Veterans RAND 12-item Health Survey (VR-12). Also included was a validated screening tool to identify PTSD (PC-PTSD) and questions about exercise and sexual activity. The VR-12 produces physical and mental health QOL summary scores (PCS and MCS) that are standardized using a T-score metric with mean of 50±10. Wilcoxon signed rank tests were used to test if median PCS and MCS scores were equal to 50. Kruskal-Wallis tests were used to test for associations between QOL and PTSD, post-AD exercise status, and limited sexual activity. Hodges-Lehmann (HL) estimates of the location shifts between the two groups and their 95% CIs are also provided as (HL [lower CI, upper CI]). Skewed distributions are presented as median [15 th , 85 th ] percentiles. Results: Median PCS (40.1 [25.9, 51.2]) was significantly lower than 50 (P<.0001). There was no statistical difference between median MCS (54.6 [33.9, 61.4]) and 50 (P=0.2454). The median PCS QOL score was significantly lower in AD patients who screened positive for PTSD than those who did not (HL: -9.3 [-14.0,-4.1], p=0.0008). The same was true for the median MCS score (HL: -17.0 [-23.1,-10.0], p<.0001). The median PCS QOL score was significantly higher in AD patients who were exercisers than those who were not (HL: 6.8 [2.4, 11.1], p=.0015). The same was true for the median MCS score (HL: 4.2 [1.0, 7.8], p=.0095). The median PCS QOL score was significantly lower in AD patients experiencing limited sexual activity after their dissection than those who did not (HL: -8.0 [-12.6, -4.3], p=.0002). The same was true for the median MCS score (HL: -5.5 [-10.5,-1.8], p=.0026). Conclusions: The traumatic and debilitating nature of AD and its emergency repair results in lower physical, but not mental, QOL scores than the general population. Lower physical and mental scores are also associated with PTSD, non-exercisers and limited sexual activity in this population. To promote physical and mental QOL in these patients, physicians should investigate and treat PTSD, encourage exercise, and promote resumption of sexual activity when safe.