Mortality and Morbidity Outcome in Marfans
Research type
Research Study
Full title
Mortality and morbidity outcomes after aorto-vascular surgery in patients with Marfan Syndrome: A UK experience
IRAS ID
294022
Contact name
Julie Sanders
Contact email
Sponsor organisation
Queen Mary University of London
Clinicaltrials.gov Identifier
Clinicaltrials.gov Identifier
NCT04774172, ClinicalTrials.gov ID
Duration of Study in the UK
1 years, 11 months, 30 days
Research summary
Marfan Syndrome (MFS) is a genetic disease affecting the eyes, skeleton, heart and arteries. Despite MFS affecting multiple organ systems, cardiovascular manifestations are the most serious and life threatening. Approximately 80% of adult MFS patients will have a dilated aortic root by age 40 years with aortic aneurysm and dissection the leading causes of morbidity and mortality. Improvement in diagnostics and medical and surgical interventions have increased life expectancy. However, the natural history and the influence of medical or surgical interventions in the UK population are not fully described. Further, the incidence of aortovascular surgery in this patient group is unknown as MFS is not routinely documented in the National Institute of Cardiovascular Outcome Research (NICOR) national cardiac surgery dataset and therefore, there is currently no mechanism for exploring the aortovascular outcomes for this patient group.
We aim to undertake a 10-year secondary analysis of linked national data (National Institute of Cardiovascular Outcome Research (NICOR), Office of National Statistics (ONS), Hospital Episode Statistics (HES)) to identify the UK incidence and outcome of aorto-vascular surgery in patients with Marfan syndrome (MFS). This includes associated hospital length of stay, mortality and morbidity rates.
Understanding mortality alongside morbidity will allow us to study further the burdens that the aortovascular manifestations may place on MFS population. It will also allow us to continuously evaluate the efficacy of either the health care system or an implemented intervention in place. Further, these metrics will be useful for the stakeholders to effectively prioritise which complications to tackle and to allocate resources toward as well as proactively manage the potential onset of a health event
Lay summary of study results: Marfan syndrome (MFS) affects multiple organ systems with cardiovascular manifestations as the most serious and life-threatening. However, mortality and morbidity outcomes following aortovascular surgery (AVS) in MFS patients have not been reported in the United Kingdom. This study aimed to identify the incidence of AVS in MFS patients and their mortality and morbidity outcomes 1-year after surgery.
Overall, 6,760 MFS patients were identified in the NHS England dataset, of which n=1026 (15.2%) had AVS. The majority (n=649 (63.3%)) were male, mean age at surgery was 43 (±1.9) years and 57% have at least one aorta segment operated on.
Sixty-nine patients (6.7%) died within one-year of surgery due to aortic dissection/ruptured aneurysm (n=34 (49.3%)) and surgical complications (n=25 (36.2%)). MFS patients had a 1.4% probability of dying from AVS on operation day and 5.5% and 1.3% within 90 days and one year of AVS, respectively.
Of the MFS patients who had AVS, 93.4% experienced subsequent hospital admissions related to AVS complications and cardiovascular problems. The number of hospital readmissions ranged from 1 to 160 times [with length of stay between <1 day to 386 days (mean 5.9 days)]. Looking at the probability of discharge, approximately 536 (52.6%) of the MFS patients who had AVS were discharged by post-operative day nine. Overall, the total number of patients discharged alive is 868 (85.2%) and the remaining 14.8% (n=151) died before hospital discharge.REC name
London - South East Research Ethics Committee
REC reference
21/LO/0680
Date of REC Opinion
17 Sep 2021
REC opinion
Favourable Opinion