Although postoperative follow-up after aortic surgery is recommended by guidelines, its clinical utility is not well documented. We hypothesized that structured follow-up imaging by an aortic program would improve outcomes. We then documented radiologic findings on asymptomatic postoperative imaging. All patients who survived to discharge after open thoracic aortic surgery between January 2017 and July 2021 were included, excluding endocarditis. Patients who followed at our center and received scheduled imaging were compared with patients who did not. Survival was analyzed by the method of Kaplan–Meier, and reintervention was assessed using the Fine–Gray subhazard function. Routine imaging was reviewed for aortic growth, pseudoaneurysm, and perigraft density. After aortic surgery, the cumulative incidence of follow-up was 38.6% at 3 years postoperatively. Patients with follow-up were more likely to have a dissection and fewer comorbidities but were similar in regards to socioeconomic factors and distance to hospital. After matching and accounting for immortal time bias, patients with follow-up had a greater reintervention rate (26.0% vs 9.0%) with similar survival (98.7% vs 95.2%, = .110) at 4 years. The cumulative incidence of pseudoaneurysm, significant perigraft density, and growth ≥3 mm/year on routine imaging was 49.7% at 3 years. Implementation of structured follow-up imaging by an aortic program resulted in low clinical compliance. Follow-up was associated with increased rates of aortic reintervention. Clinically relevant radiologic findings were common on asymptomatic imaging and increased throughout 5-year follow-up rather than plateauing in the early postoperative period.

中文翻译：

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主动脉手术后结构化随访成像的实用性

尽管指南建议对主动脉手术后进行术后随访，但其临床实用性尚未得到充分记录。我们假设主动脉计划的结构化随访成像可以改善结果。然后我们记录了无症状术后影像学的放射学结果。纳入2017年1月至2021年7月期间开胸主动脉手术后存活并出院的所有患者，不包括心内膜炎。将在我们中心随访并接受预定成像的患者与未接受成像的患者进行比较。通过 Kaplan-Meier 方法分析生存率，并使用 Fine-Gray 亚危险函数评估再干预。常规影像学检查主动脉生长、假性动脉瘤和移植物周围密度。主动脉手术后，术后3年的累积随访发生率为38.6%。进行随访的患者更有可能发生夹层和较少的合并症，但在社会经济因素和到医院的距离方面相似。匹配并考虑永生时间偏差后，随访患者的再干预率更高（26.0% vs 9.0%），4 年生存率相似（98.7% vs 95.2%，= .110）。3 年时，常规影像学显示假性动脉瘤、移植物周围明显密度和生长≥3 毫米/年的累积发生率为 49.7%。通过主动脉计划实施结构化随访成像导致临床依从性较低。随访与主动脉再干预率增加相关。临床相关的放射学发现在无症状影像学中很常见，并且在整个 5 年随访期间有所增加，而不是在术后早期趋于稳定。